scope of service - hamilton county job & family services
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EMERGENCY PLACEMENT SERVICES QUOTE (SC05-19Q)
The Hamilton County Department of Job & Family Services (HCJFS) is seeking proposals for
the purchase of emergency placement services for children.
Scope of Service:
Hamilton County has been engaged in a participatory planning effort to improve the availability
and quality of emergency placement opportunities for children in the county. As part of the
effort, we are seeking a service Provider who will provide emergent, local, safe, community-
based, trauma-informed placements for children age 0-13. Placements of this nature should
provide a temporary sanctuary for children and allow children to be children in crisis situations.
Providers shall use an integrated, trauma-informed care approach, providing a foundation of
healing for each child. Coordination of care for school, medical care, visits, and therapeutic
services will occur immediately. Children will be given the opportunity for coping skill
development in this time of crisis. These placements should be available 24 hours a day, 7 days a
week and will have a no-reject, no-eject policy. Congregate care options will be considered.
This emergent placement shall have the ability to provide to the HCJFS casework staff an
assessment of the child’s needs through combined observation, interaction and professional
assessment. This assessment should include the child’s strength, needs, daily routine, likes,
dislikes, special care requirements, etc. This assessment shall also include any pertinent family
functioning or suggestions regarding safety interventions for the family which would allow the
child to reunify with the family or assist HCJFS staff to secure appropriate long-term placements
within 14 days. HCJFS has a strong interest and preference to place children with kin when
parents are not an immediate, feasible option.
HCJFS’ goal is to work with Providers who are able to meet the entire continuum of services.
Contract Term:
The contract term will be one (1) year.
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Population:
The following data is provided for planning purposes only. HCJFS does not guarantee that the
current service level will increase, decrease or remain the same. In 2014, HCJFS served 1394
children in paid placements. In 2015, HCJFS served 1766 children in paid placements. In 2016,
HCJFS served 2039 children in paid placements.
The total number of children in care has increased as has the percentage of younger children
coming into care. The representation of 0-3 year-olds in care has increased by 39% in the last
year. Children aged 0-6 are nearly half the population. The numbers listed here are for the total
number of placements. The service being procured is new, therefore, we are unable to provide
current numbers specifically for emergency placements.
The service level described herein is for information purposes only and is HCJFS’ best estimate
as to the number of customers that it will serve during the Initial Term. Provider understands that
HCJFS is not making any guarantees or assurances as to the quantity of services it will purchase
under the Contract.
Service Components:
HCJFS is seeking service Providers who reinforce the value of serving children within their
family and community in a well-coordinated system of care which is: seamless for the
children/families; culturally competent; standardized in terms of multi-disciplinary assessment;
outcome driven; cost-effective; and collaborative in building upon partnerships with Providers
and funders in sustaining quality services.
HCJFS is looking for organizations to provide community-based, emergency placement services
for the child welfare population of Hamilton County who meet emergency services criteria for
this placement setting. In addition, HCJFS is seeking service Providers who are able to: increase
stability for child in placement; maintain sibling placements; engage families; achieve school
stability and success; and provide emergency therapeutic interventions using a trauma responsive
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approach. Providers must demonstrate their ability to use community resources and supports as a
part of treatment planning and in support of continuity of care with existing services, and their
capacity to communicate and work collaboratively with professionals, courts, children and the
child’s family.
Organization(s) with strong behavioral management intervention strategies and evidence-based
practices shall provide temporary, emergency, out-of-home placement services primarily for
children awaiting long term placements or safely return to their natural family environment with
supports and interventions focused on the entire family.
The Provider must work hand-in-hand with the assigned HCJFS caseworker and other
community stakeholders. Provider must be aligned with Ohio Child Protection Oversight and
Evaluation (CPOE) for safety, permanency and well-being indicators and standards of practice
must be consistent with the legal framework of child welfare and its values.
Services will be individualized and capitalize on the strengths of the child and the family. The
following service components shall be available to the children residing in emergency care:
1. Substitute Care - Provider shall make placement based on the criteria outlined in the
referral and the identified need for emergency placement as identified by HCJFS.
2. Referral Response Time - Provider must be able to respond to emergency calls from
HCJFS staff. Emergency and after-hour referrals require a response within 30 minutes of
referral with potential placement options. Provider must be responsive and available to
accept emergency referrals on any day of the year. These services are intended to be
short-term. A same day referral for placement will not be considered as an emergency
placement as it relates to this Contract.
3. Housing and Supervision - Shared housing within a community setting in accordance
with OAC 5101:2-9 et seq. and local requirements:
A. No more than four children per bedroom. Preference is no more than 2 per room.
B. Each child shall be provided with a bed of his/her own, appropriate bedding, and a
dresser or chest of drawers for clothing and personal items.
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C. All children who share a bedroom in placement must be within 2 years of age of
each other. Exceptions must be approved by HCJFS. For children with
developmental disabilities, their developmental age should be considered.
D. 24 hour awake supervision must be provided.
E. Must include a ratio of not more than five (5) children to one (1) staff during peak
hours. Peak hours shall be defined as 3:00 p.m. to 11:00 p.m. on school days and
8:00 a.m. to 11:00 p.m. on non-school days.
Provider must have identified supervisor on-call at all times. Staffing levels
should support ability to ensure a child’s participation in varying individual
community activities including mental health appointments, visitation, recreation
activities, employment, etc.
F. The emergency placement should offer a family “home-like” environment with
comfortable, adequate furnishings, window coverings, individualized child décor
(wall decorations, art, bedding, and equipped study areas) and well-maintained,
usable outdoor space.
G. The placement’s temperature shall be monitored for resident comfort with heat/air
conditioning provided as needed.
4. Transportation – Is to be provided at no additional cost for medical appointments, court,
school (unless otherwise provided by the school district), therapy appointments, child and
family team meetings, recreational activities, home visits and family visitations
(supervised visits, sibling visits, etc.), adoption readiness groups, educational or
mentoring programs, and other services associated with case plan goal attainment. Any
person transporting a child shall have current, valid driver’s license with less than 6
points from violations, safety restraints according to Ohio and have current insurance (as
further detailed within the sample Contract, Attachment B to this RFP). Non-Emergency
Medicaid Transportation is to be used to offset transportation costs whenever permissible.
5. Basic Needs - Provider shall meet all basic needs for safety, food, clothing, shelter
emotional and gender child most identifies with. Meals are provided in accordance to a
child’s developmental, growth and health needs and take into account federal nutrition
guidelines. Healthy snacks are available for children in between regularly scheduled meal
times. Clothing is seasonally appropriate, laundered regularly, in good condition and
replaced as necessary to accommodate growth, weight and age. Age and developmentally
appropriate personal care items are provided at no cost to the child. This includes such
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items as body soap, shampoo, clean towels, hair care products, shaving items, lotions,
deodorant, etc.
Gender identification need is met by addressing or referencing a child by the gender they
most identify with without regard to staff’s personal beliefs of which gender child should
identify with.
6. Medication Monitoring - In compliance with the requirements of the Ohio Department of
Job & Family Services (ODJFS), including but not limited to administration by adults,
record keeping, etc.
7. Educational Services - Educational services shall include ensuring that the child
continues to remain and attend their current school of residence or is engaged in some
type of educational activity if they are of school age and not currently enrolled. Provider
will offer advocacy, enrollment, monitoring, tutoring, record-keeping, and transitional
planning support, collaboration and cooperation with efforts to promote school stability
and success, ensure school attendance, and provide ongoing communication and
information related to child’s progress and needs to HCJFS. Child will continue to
participate in extra-curricular activities that are already in place.
8. Computers and Internet Access - Must be available to child for use for education, and
social access as appropriate and needed on site. All internet use should be monitored
appropriately by staff.
9. Case Management – Working closely with the HCJFS caseworker will allow for the
planning and implementation of strength-based, child and family-centered, goal- oriented,
long-term placement planning for the child. Activities performed for the purpose of
providing, recording and supervising service to children and their parents, guardians,
custodians, caretakers, or substitute caregivers. Case management is responsible for:
A. Coordinating interdisciplinary care services (i.e. clinical treatment, behavior
management, education, health, nutrition, medication management, mental health,
recovery, social and recreational services, life skills etc.);
B. Developing, in collaboration with the child, family, and treatment team, plans of
care to meet each child’s emergent needs (examples may include but not be limited
to: DAFs, medication management, psycho/social needs assessment, observation
feedback, etc.);
C. Engagement of family and identification of resources to support a quick, safe,
reunification free from present or impending dangers; and
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D. Linkage to community services to support reunification or next placement as
appropriate.
10. Legal – Provider will provide court appearances and testimony, and reports to the court.
Provider will attend court review hearings, semi-annual reviews (SAR) and children
should attend court hearings as permitted by their age, maturity, willingness and
schedule. Provider will transport children to all court hearings.
11. Weekly Progress Reports – Weekly progress reports will include well-documented
contact with children, family, case worker and other professionals involved with the
child. Overall assessment of child’s progress, interventions utilized, child’s ongoing
adjustment to placement, safety and well-being, recreational and social activities, family
or sibling visits, and strengths and areas of concern. Recommendations for next
placement including an assessment of the viability of family will be included in the
progress report. Provider will record and submit this information on the Southwest Ohio
Regional Collaborative (SORC) form.
12. Crisis Support – Crisis support plans will be developed within 1 day of placement and
include the child, caseworker, and when possible the family. Plans are to be well-
documented, individual, crisis plans for each child and all staff charged with caring for
the child will be aware of the plan. Plans will be established to respond to the needs of
the child and reduce the incident of hospitalization, arrests, AWOL or aggressive
behavior and will promote a positive outcome for the child. Plans may not rely
exclusively on police or hospital interventions. The custodial agency must approve the
established plan.
13. Interventions/Assessment – Emergency individual and family interventions are to be
provided on site or arranged within the community and provided through a qualified
clinician. Assessments are to be provided to the child and family as needed for further
placement planning and service provision. The counselor is prohibited from serving a
dual role as child case manager.
14. Limited English Proficiency – Interpreter or services available for children with Limited
English Proficiency.
15. Licensure –Providers must maintain appropriate licensure from Ohio Department of Job
& Family Services (ODJFS), Ohio Department of Mental Health (ODMH) or Ohio
Department of Developmental Disabilities (ODDD).
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16. Staff Training – All staff will receive formal training related to trauma that will result in
the Provider’s ability to better manage children leading to better outcomes including
placement stability, functional stability and decreased disruptions within 1 year of hire.
All staff will receive formal training related to the goals, laws and roles of the child
welfare system within 6 months of hire
17. Structural Conditions – Structures associated with all living arrangements are to be
maintained in a safe state of repair and in accordance with all ODJFS, ODMH and DD
requirements, depending upon the licensing entity responsible for oversight.
18. Quality Improvement (QI) Outcomes - Established outcome measurement practices.
Outcomes are utilized to inform HCJFS of quality improvement initiatives and service
effectiveness. Annual reports are to be made available to HCJFS and include outcomes
related to:
A. Stability of placement;
B. Number of assessments;
C. Family engagement;
D. Incidence of abuse/neglect:
E. Child and family satisfaction;
F. Staff development training including evidence-based practices; and
G. TBD.
20. Health Care - All children are to be provided with immediate required health screens,
routine and specialized medical and dental care in accordance with Ohio Administrative
Code.
21. Discharge and Transition Planning and Activities. Discharge and transition planning will
include time frames and recommendations for next placement and services with
accompanying discharge reports and summaries including:
Prior to Discharge and Transition:
A. Provider shall coordinate a treatment team meeting prior to a child’s discharge.
The meeting will include the child as appropriate, custodial agency staff, parent,
provider staff, CASA or GAL, relative, and behavioral health or other relevant
service Providers. The purpose of the meeting is to develop a comprehensive
assessment and plan for a child’s transition.
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B. Provider shall work cooperatively with child’s team to coordinate all necessary
transitional services such as living arrangements, health, education, medication,
community support, behavioral health, visitation/ pre-placement visits and after
care services. Provider shall extend service provision for health, education,
treatment and community support to facilitate continuity of care for the child and
family.
C. Provider shall facilitate the coordination of all records including school records,
updated health and medical records, and behavioral health records.
1. Provider shall prepare and submit a discharge summary report within 7 days
of the child’s discharge.
2. At the day of discharge, Provider shall provide 30 days of medication, updated
scripts or follow up appointment for medication.
3. At the day of discharge, Provider shall release all of the child’s personal
belongings and ensure the child transitions with a 7-day supply of clothing
that is appropriately sized, seasonally appropriate and in good repair.
22. Visitation – Within the first day of placement Provider will arrange and provide family
visitation in coordination with HCJFS and the family. Visitation is to be flexible and
tailored to meet the needs of the child and family, in the least restrictive setting, which is
most likely to enhance reunification outcomes. Provider will not restrict visitation for
reasons of punishment to the child.
23. Child and Family Engagement Activities – Including but not limited to:
A. Child and family’s participation and input into all aspects of planning, including
placement, treatment, education, health, social, independent living and discharge
planning;
B. Routine and ongoing communication between Provider, birth families and
professional staff as it pertains to daily care, visitation, treatment and permanency
planning;
C. Family visits;
D. Parent mentoring and teaching program components; and
E. Family participation in child’s day-to-day living activities such as school and health.
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Questions:
Bidder must respond to the following questions:
1. Demonstrate Provider’s ability to meet: Scope of Services, Population; and the Service
Components. Include a statement describing the population you currently serve. Also
include a statement describing what Provider resources and experiences will support this
program.
2. Describe how Provider will ensure all referrals are processed and timelines are met,
including the accommodation of sibling sets.
3. Describe and provide examples of how housing, transportation, and the basic needs of
children will be met. Describe and provide examples of how Provider will ensure families
and children are involved and incorporated into all aspects of placement planning, and
daily living.
4. Describe and provide examples of how education planning and educational services will be
provided to the child and shared with the HCJFS caseworker.
5. Describe and provide examples of how case management services will be provided to the
child and family and coordinated with the JFS case worker.
6. Describe and provide detailed examples of how the Provider will develop a visitation plan
with the child and family, including sibling sets.
7. Describe and provide detailed examples of how Provider will develop crisis plans and
provide trauma-informed crisis support. Plans should be comprehensive and trauma-
informed.
8. Please explain in detail if your organization is currently licensed and by which licensing
agency.
9. Provide copies of aggregate outcome reports and/or evaluation reports of the past 12
months of service for similar programing. Describe how information is utilized to improve
program outcomes and effectiveness. Include the following data:
A. Stability of placement;
B. Number of assessments;
C. Family engagement;
D. Incidence of abuse/neglect;
E. Child and family satisfaction;
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F. Staff development training including evidence-based practices; and
10. Provide an example of how Provider will ensure discharge planning results in positive
transitions and outcomes for children.
11. Describe how Provider will ensure all children receive timely routine and specialized
medical, vision and dental care in accordance with OAC, and how documentation will be
submitted to HCJFS for child’s case records and how documentation will be submitted to
HCJFS.
12. Describe what additional services will be provided to a child including the type of contact
and frequency. Individual Aid services are a separately authorized service that provides
short-term one-on-one services, delivered typically by para-professionals, to support
Providers and children. Individual Aids ae expected to work with and assist Providers meet
the children’s needs and ensure placement stability.
Staff information
1. Provide a description of your organization’s employee screening and clearance policy.
Include volunteers and interns in your response and how you will ensure criminal checks
including BCII and FBI are obtained prior to staff working directly with children.
2. Describe your organization’s policy and practice standards for training, supervision, and
support provided to direct care staff. What steps will you take to ensure all staff are trained,
have skills and competencies to work with children who have experienced high levels of
exposure to trauma and understand child welfare?
3. Provide a description of Provider’s training, clearance and screening for all staff. Include
any specialized assessments used to determine a staff’s suitability to work with children
and families involved in the child welfare system.
Licensure, Administration and Training
1. Maintain appropriate licensure from ODJFS, ODMH, ODDD, or other appropriate
licensing agency at all times. Indicate if you are a Medicaid certified facility. Indicate
whether your organization is accredited. If so, by whom?
2. Identify any actions against your organization through ODJFS, ODMH or any other
licensing body over the past 2 years that included Corrective Action Plans, Temporary
License or Revocation. For the past 10 years, provide outcome of any action that resulted in
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a revocation.
3. Provide a description of your organization’s employee screening and clearance policy.
4. Describe training, supervision, and support provided to staff.
Questions from Providers:
Questions regarding this quote must be e-mailed to Sandra Carson, [email protected]
co.org on or before October 4, 2019 no later than noon. Questions will also be posted on
HCJFS’ website at www.hcjfs.org (select About and then Request for Quotes). HCJFS will
answer questions no later than October 11, 2019 by the close of business.
Cost of Service Chart:
Complete the following cost of service chart. All costs associated with delivery of a unit of
service should be included in your unit rate. In addition, complete the budget worksheet
attached to this RFQ and show how the per diem is calculated.
Service Unit rate
$ /day
$ /hour
Bid Submission:
Please submit bid by October 25, 2019 no later than 12:00 p.m. EST one of the following
ways:
1) E-mail:
Sandra Carson
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2) Fax:
Attention: Sandra Carson
Fax # 513-946-2384
3) Mail:
Hamilton County Job & Family Services
Attention: Sandra Carson – Contract Services 3rd Floor
222 East Central Parkway
Cincinnati, Ohio 45202
EXHIBIT II
AGENCY: BUDGET PREPARED FOR PERIOD
NAME OF CONTRACT PROGRAM: ___________ TO _____________
INDICATE NAME OF SERVICE IN APPROPRIATE COLUMN BELOW
EXPENSES BY PROGRAM SERVICES
Emergency
Placement
MGMT
INDIRECT
OTHER DIRECT
SER
TOTAL
EXPENSE
A. STAFF SALARIES 0.00
B. EMPLOYEE PAYROLL TAXES & BENEFITS 0.00
C. PROFESSIONAL & CONTRACTED SERVICES 0.00
D. CONSUMABLE SUPPLIES 0.00
E. OCCUPANCY 0.00
F. TRAVEL 0.00
G. INSURANCE 0.00
H. EQUIPMENT 0.00
I. MISCELLANEOUS 0.00
J. PROFIT MARGIN 0.00
K. SUB-TOTAL OF EXPENSES BEFORE MGMT
INDIRECT ALLOCATION 0.00 0.00 0.00 0.00 0.00
ALLOCATION OF MGT/INDIRECT COSTS 0.00
TOTAL PROGRAM EXPENSES 0.00 0.00 0.00 0.00 0.00
ESTIMATED TOTAL UNITS OF SERVICE
TO BE PROVIDED: UNIT =
TOTAL PROGRAM COST/TOTAL UNITS
OF SERVICE = UNIT COST: $___________ $___________
Summary
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Ohio Department of Job and Family ServicesAGREEMENT FOR TITLE IV-E AGENCIES AND PROVIDERS FOR THE PROVISION
OF CHILD PLACEMENT
This Agreement sets forth the terms and conditions between the parties for placement services for children who are in the care and custody of the Agency named below.
This Agreement is between Hamilton County Department of Job and Family Services, a Title IV-E Agency, hereinafter "Agency," whose address is:
Hamilton County Department of Job and Family Services222 E Central PKWY FL 5
Cincinnati, OH 45202
and Agency Name , hereinafter "Provider," whose address is:
Agency Name StreetCity , ST Zip
Collectively the "Parties."
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Table of Contents
ARTICLE I. SCOPE OF PLACEMENT SERVICES 3 Section 1.01 FOR AGREEMENTS COMPETITIVELY PROCURED 3 Section 1.02 FOR AGREEMENTS NOT COMPETITIVELY PROCURED 3 Section 1.03 EXHIBITS 3ARTICLE II. TERM OF AGREEMENT 4ARTICLE III. ORDER OF PRECEDENCE 4ARTICLE IV. DEFINITIONS GOVERNING THIS AGREEMENT 4ARTICLE V. PROVIDER RESPONSIBILITIES 5ARTICLE VI. AGENCY RESPONSIBILITIES 6ARTICLE VII. INVOICING FOR PLACEMENT SERVICES 7ARTICLE VIII. REIMBURSEMENT FOR PLACEMENT SERVICES 7ARTICLE IX. TERMINATION; BREACH AND DEFAULT 8ARTICLE X. RECORDS RETENTION AND CONFIDENTIALITY 9ARTICLE XI. PROVIDER ASSURANCES AND CERTIFICATIONS 9ARTICLE XII. INDEPENDENT CONTRACTOR 10ARTICLE XIII. AUDITS AND OTHER FINANCIAL MATTERS 11ARTICLE XIV. GRIEVANCE /DISPUTE RESOLUTION PROCESS 11ARTICLE XV. AMENDMENTS 11ARTICLE XVI. NOTICE 12ARTICLE XVII. CONSTRUCTION 12ARTICLE XVIII. NO ASSURANCES 12ARTICLE XIX. CONFLICT OF INTEREST 12ARTICLE XX. INSURANCE 13ARTICLE XXI. INDEMNIFICATION & HOLD HARMLESS 14ARTICLE XXII. SCREENING AND SELECTION 14ARTICLE XXIII. PROHIBITION OF CORPORAL & DEGRADING PUNISHMENT 15ARTICLE XXIV. EXCLUDED PARTIES LIST 15ARTICLE XXV. PUBLIC RECORDS 15ARTICLE XXVI. CHILD SUPPORT ENFORCEMENT 15ARTICLE XXVII. DECLARATION OF PROPERTY TAX DELINQUENCY 16ARTICLE XXVIII. SUBCONTRACTING AND DELEGATION 16ARTICLE XXIX. PROPERTY OF AGENCY 16ARTICLE XXX. WAIVER 16ARTICLE XXXI. NO ADDITIONAL WAIVER IMPLIED 16ARTICLE XXXII. COUNTERPARTS 16ARTICLE XXXIII. APPLICABLE LAW AND VENUE 16ADDENDA TO THIS AGREEMENT 18
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RECITALSWHEREAS, the Agency is responsible under Ohio Revised Code (ORC) Title 51, Chapter 5153 for the provision of protective services for dependent, neglected, and abused children; and,
WHEREAS, the Agency is authorized under ORC Title 51, Chapter 5153.16 to provide care and services which it deems to be in the best interest of any child who needs or is likely to need public care and services; and,
WHEREAS, the Provider is an organization duly organized and validly existing and is qualified to do business under the laws of the State of Ohio or in the state where the placement facility or foster home is located and has all requisite legal power and authority to execute this Agreement and to carry out its terms, conditions and provisions, and is licensed, certified or approved to provide placement and related services to children in accordance with Ohio law or the state where the placement facility or foster home is located.
NOW, THEREFORE, in consideration of the mutual promises and responsibilities set forth herein, the Agency and Provider agree as follows:
Article I. SCOPE OF PLACEMENT SERVICESIn addition to the services described in Exhibit I-Scope of Work, Provider agrees to provide and shall provide the placement and related services specified in each Individual Child Care Agreement (ICCA) for children in the care and custody of the Title IV-E Agency. The ICCA shall be consistent with current federal, state and local laws, rules and regulations applicable to the Provider’s license or certified functions and services. If an Agreement and ICCA both exist, the Agreement supersedes.
Section 1.01 FOR CONTRACTS COMPETITIVELY PROCUREDWithout limiting the services set forth herein, Provider will provide the Services pursuant to and consistent with the Requests for Proposals (RFP) and the Provider’s Proposal submitted in response to the RFP, the Provider agrees to provide and shall provide the placement and related services described in Exhibit I-Scope of Work.
Section 1.02 FOR CONTRACTS NOT COMPETITIVELY PROCUREDThe Provider agrees to provide and shall provide the placement and related services described in the Exhibit I-Scope of Work.
Section 1.03 EXHIBITSThe following exhibits are deemed to be a part of this Agreement as if fully set forth herein:
A. Exhibit I – Scope of Work;B. Exhibit II – Request for Proposals (if applicable);C. Exhibit III – Provider’s Response to the Request for Proposals (if applicable); andD. Exhibit IV – Schedule A Rate Information.
Article II. TERM OF AGREEMENTThis Agreement is in effect from DATE through DATE, unless this Agreement is suspended or terminated
pursuant to Article IX prior to the termination date.In addition to the initial term described above, this Agreement may be extended at the option of the Agency and upon written agreement of the Provider. Notice of Agency’s intention to extend the Agreement shall be provided in writing to Provider no less than 90 calendar days before the expiration of any Agreement term then in effect. (If a previous Request for Proposal [RFP] allows, the Agreement may be extended for a period of time to ensure adequate completion of the Agency’s competitive procurement process at the rates existing for the term then in effect.)
Article III. ORDER OF PRECEDENCE
This Agreement and all Exhibits are intended to supplement and complement each other and shall, where possible, be so interpreted. However, if any provision of this Agreement irreconcilably conflicts with an Exhibit, this Agreement takes precedence over the Exhibit(s). In the event there is an inconsistency between the Exhibit(s), the inconsistency shall be resolved in the following order:A. Exhibit I – Scope of Work; thenB. Exhibit II – Request for Proposals (if applicable); thenC. Exhibit III – Provider's Proposals (ifapplicable); thenD. Exhibit IV – Title IV-E Schedule A Rate Information.
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Article IV. DEFINITIONS GOVERNING THIS AGREEMENTThe following definitions govern this Agreement:
A. Agreement means this Agreement, addenda and exhibits thereto.B. Material Breach shall mean an act or omission that violates or contravenes an obligation required under the
Agreement and which, by itself or together with one or more other breaches, has a negative effect on, or thwartsthe purpose of the Agreement as stated herein. A Material Breach shall not include an act or omission, which has atrivial or negligible effect on the quality, quantity, or delivery of the goods and services to be provided under theAgreement.
C. Child(ren) means any person under eighteen years of age or a mentally or physically handicapped person undertwenty-one years of age in the Agency’s custody and under the care of the Provider for the provision of placementservices.
D. All other definitions to be resolved through Federal Regulations, Ohio Administrative Code (OAC) 5101:2-1-01 andany related cross-references.
Article V. PROVIDER RESPONSIBILITIES
A. Provider agrees to participate with Agency in the development and implementation of the Case Plan and ICCAincluding participation in case reviews and / or semi-annual administrative reviews, and the completion ofreunification assessments for the children in placement with the Provider. Parties shall make best efforts to shareinformation timely regarding participants and contact information involved with planning efforts related to childrenand families.
B. Provider agrees to provide services agreed to in the Case Plan and ICCA (i.e.,transportation of children for routineservices, including, but not limited to, court hearings, medical appointments, school therapy, recreational activities,visitations/family visits) unless otherwise negotiated in writing as an attachment to this Agreement. Any disputesinvolving services or placement will be resolved through mutual-agreement and modification to the ICCA. Provideragrees the Agency is the final authority in the process. The cost of providing these services is to be included in theAgency approved per diem.
C. Provider agrees to ensure that any and all persons who may act as alternative caregivers or who have contact withthe children are suitable for interaction pursuant to all applicable federal, state and local laws and regulations.
D. Provider agrees that all caregivers must be approved by the Agency.E. Provider agrees to submit a progress report as negotiated by the parties for each child. The progress report will
be based on the agreed upon services to be delivered to the child and/or family and will include documentation ofservices provided to the child and/or discharge summary. If Monthly Progress Reports are not received within 90calendar days following the month of service provision, payment may be withheld at the Agency’s discretion.1. Monthly Progress Reports shall be submitted by the 20th of the month following the month of service.2. The Monthly Progress Report will include the following medical related information:
a. Service type (i.e. medical, dental, vision, etc.);b. Date(s) of service;c. Reason for visit (i.e. routine, injury, etc.);d. Practitioner name, address and contact number;e. Name of hospital, practice, urgent care, etc.;f. Prescribed medications and dosages;g. Date(s) medication(s) were prescribed or changed; andh. Changes to medications.
F. Placement changes, emergency or non-emergency, shall occur only with the approval of the Agency. Thefollowing information shall be provided to the Agency for all placement changes: Name, address and phonenumber of the new foster home or other out-of-home care setting, the license/home study of the new care providerwithin 24 hours, excluding weekends and holidays.
G. Provider agrees to notify all Agencies who have children placed in the same caregiver’s home/group home/CRCwhen any child residing in the placement is critically injured or dies in that location. Notification will be made to theAgencies’ Child Abuse/Neglect Hotline number or assigned Caseworker immediately.
H. Notification to the Agency of Emergency Critical Incidents shall occur ASAP but no later than one hour of theIncident becoming known. Notification will be made to the Agency via the Agency’s Child Abuse\Neglect Hotline or
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assigned Caseworker or by other established system. Critical incidents are those incidents defined in the Ohio Administrative Code that are applicable to the licensed or certified programs(ODJFS 5101:2-7-14, 5101:2-9-23 ODMHAS 5122-30-16, 5122-26-13, DODD 5123:2-17-02).
Emergency situations include but are not limited to the following:
1. Absent Without Leave (AWOL);2. Child Alleging Physical or Sexual Abuse/Neglect;3. Death of Child;4. Illicit drug/alcohol use, Abuse of medication or toxic substance;5. Sudden injury or illness requiring an unplanned medical treatment or visit to the hospital;6. Perpetrator of Delinquent/Criminal Act (Assault, Dangerous Behaviors,Homicidal Behaviors);7. School Expulsion/Suspension (formal action by school);8. Self-Injury (Suicidal Behaviors, Self-Harm Requiring external Medical Treatment, Hospital or ER);9. Victim of assault, neglect, physical or sexual abuse;10. The filing of any law enforcement report involving the child.
I. The Provider also agrees to notify the Agency within Twenty-four (24) hours, of any non-emergency situations.Non-emergency situations include but are not limited to the following:
1. When physical restraint is used/applied; and2. Medication lapses or errors.Notification will be made to the Agency via the Agency’s Child Abuse\Neglect Hotline/assigned Caseworker or by other established notification system.
J. Documentation of the emergency and non-emergency incidents as identified in “H and I” above shall be providedto the Agency via email, fax or other established notification system within 24 hours excluding weekends andholidays.
K. The Provider agrees to submit each child’s assessment and treatment plans as completed but no later than the30th day of placement. Provider further agrees to provide treatment planning that will include, but is not limited to,education on or off site, preparation for integration into community-based school or vocational/job skills training,community service activities, independent living skills if age 14 or older, monitoring and supporting communityadjustment.
L. The Provider agrees to participate in joint planning with the Agency regarding modification to case plan services.Provider agrees that while the Provider may have input into the development of the child's case plan services andthe ICCA, any disputes involving services or placement will be resolved through mutual agreement andmodification to the ICCA. Provider agrees the Agency is the final authority in the process.
M. The Provider shall participate in a Placement Preservation meeting if requested by the Agency prior to issuing anotice of removal of a child. A placement Preservation meeting shall be held within seven (7) business days ofsaid request. Unless otherwise mutually agreed upon a minimum of thirty (30) calendar days’ notice shall be givenif placement preservation is unable to be achieved. A Discharge Plan Summary shall be provided no later thanfifteen (15) calendar days after the date of discharge in accordance with the applicable licensed or certifiedprogram. (OAC 5101:2-5-17, OAC 5122-30-22, OAC 5122-30-04, OAC 5123:2-3-05).
N. The Provider shall work in cooperation and collaboration with the Agency to provide information for each child'sLifebook and will fully comply with the provision of OAC 5101:2-42-67 as applicable to private Providers. Provider'scontribution to the Agency Lifebook for a child shall be for the episode of care with the Provider.
O. The Provider agrees to provide Independent Living Services as set forth in accordance with OAC 5101:2-42-19 forall children age 14 and above.
P. When applicable, due to the Provider being part of a managed care agreement as defined in OAC 5101:2-1-01,the Provider agrees to visit with the child face-to-face in the foster home, speak privately with the child and to meetwith the caregiver at least monthly in accordance with rule OAC 5101:2-42-65 of the Ohio Administrative Code.
Q. The Provider agrees to maintain its licenses and certifications from any source in good standing. The Provideragrees to report to Agency in writing any change in licensure or certification that negatively impacts such standingimmediately if the negative action results in a temporary license, suspension of license or termination of license.
R. Provider agrees that the reasonable and prudent parent standard training required by SEC. 471. [42 U.S.C. 671] ofthe Social Security Act and in accordance to OAC 5101:2-5-33, OAC 5101:2-9-02 or OAC 5101:2-9-03 has been
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completed.S. The Provider shall notify Agency of any changes in its status, such as intent to merge with another business or to
close no later than forty-five (45) business days prior to the occurrence.T. The Provider agrees that the Agency shall have access to foster parent home studies and re-certifications for
foster parents caring for children in placement, subject to confidentiality considerations. The Provider shall submitto Agency a copy of the current foster home license at the time of placement and recertification. Provider alsoagrees to notify Agency within twenty-four (24) hours of any change in the status of the foster home license.
U. When there is a rule violation of a caregiver, a copy of the corrective action plan, if applicable, must be submittedto the Agency when the investigation is complete.
V. The Provider agrees to notify the Agency of scheduling no less than fourteen (14) calendar days prior to all formalmeetings (i.e. FTMs, Treatment Team Meetings, IEPs, etc.).
W. The Provider agrees to adhere to the following Medical/Medication guidelines:
1. To provide over-the-counter medications and/or supplies as part of the per diem of care;2. To comply with the medical consent process as identified by Agency;3. Only the Agency can give permission for the administering or change (addition or elimination) of psychotropic
medication and its ongoing management; and4. Provide an initial placement medical screening within 72 hours of child’s placement into a placement resource
under the Provider’s operation and/or oversight.
X. To arrange for required health care/medical examinations within time frames required by OAC 5101:2-42-66.1andprovide reports from the health care providers to the agency within 30 days of occurrence if the appropriatereleases of information have been obtained by the Provider.
Y. The Network Provider agrees to notify the Agency if placement resource is currently under investigation for licenseviolations or misconduct toward children or other third-party investigation.
Z. The Provider will immediately notify the Agency:
1. If the Provider is out of compliance with any licensing authority rules or the placement resource is underinvestigation for license violations or misconduct toward children. Immediately is defined as within one hour ofknowledge of the non-compliance issue.
2. Child Abuse/Neglect Hotline or assigned Caseworker of any allegations of abuse or neglect made against theCaregiver within one hour of gaining knowledge of the allegation.
3. Of any corrective action and the result of the correction action plan. The Provider will submit a comprehensivewritten report to the agency within sixty (60) days of the rules violation.
4. Within twenty-four (24) hours any time there is an event which would impact the placement resource license.
Article VI. AGENCY RESPONSIBILITIES
A.
Agency certifies that it will comply with the Multiethnic Placement Act, 108 STAT. 3518, as amended by Section1808 of the Small Business Jobs Protection Act of 1996, 110 STAT. 1755, which prohibits any Agency fromdenying any person the opportunity to become an adoptive or foster parent on the basis of race, color, nationalorigin, or delaying or denying the placement of a child for adoption or into foster care on the basis of race, color,or national origin of the adoptive or foster parent or of the child involved.
B. The Agency shall provide to the Provider within thirty (30) calendar days of placement or within a reasonable timethereafter as agreed to by the parties, a copy of each child's social history, medical history, and Medicaid cardonce obtained by the Agency for new cases, or at time of placement for existing cases. Agency shall make bestefforts to share information timely regarding participants and contact information involved with planning effortsrelated to children and families.
C. Agency agrees to participate in the development of the treatment plan of each child placed with the Provider. TheAgency acknowledges that clinical treatment decisions must be recommended by licensed clinical professionals.Agency and Provider acknowledge that disagreement with a treatment decision may be taken through the disputeresolution process contained in Article XIV of this Agreement.
D. Agency agrees to visit with the child in accordance with rule OAC 5101:2-42-65 of the Ohio Administrative Code.E. Agency agrees to participate in periodic meetings with each child’s treatment team for case treatment plan
development, review, and revision. The Agency agrees to participate in the development of the treatment plan ofeach child placed with the Provider by the Agency.
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F. Agency certifies that it will comply with Every Student Succeeds Act (34 CFR part 200) and will work with localschool districts in developing individualized plans to address the transportation needed for a child to remain in theschool of origin. Agency agrees to arrange for the transfer of each child’s school records to the child’s new schoolupon placement but not later than ten (10) business days. The Agency agrees to work with the Provider for thetimely enrollment of the child in the receiving school district. The Agency has the final responsibility to obtain thechild’s school records and to enroll the child in the receiving school district.
G. The Agency shall provide an opportunity for the Provider to give input in the development, substantiveamendment or modification of case plans. The Agency agrees to notify the Provider of scheduling no less thanseven (7) calendar days prior to of all formal meetings (e.g. SARs, court hearings, family team conferences, etc.).
H. The Agency shall participate in a Placement Preservation meeting if requested by the Provider prior to issuing anotice of removal of a child. The Agency shall provide a minimum of thirty (30) calendar days’ notice for plannedremovals, to the Provider for each child who is being terminated from placement with the Provider, unless soordered by a court of competent jurisdiction.
I. Agency agrees to provide the Provider with an emergency contact on a twenty-four (24) hour, seven (7) day perweek basis.
J. The Agency represents:1. It has adequate funds to meet its obligations under this Agreement; subject to the availability of funds as
referenced in Article VIII (I);2. It intends to maintain this Agreement for the full period set forth herein and has no reason to believe that it will
not have sufficient funds to enable it to make all payments due hereunder during such period; and3. It will make its best effort to obtain the appropriation of any necessary funds during the term of this
Agreement.
K. The Agency will provide information about the child being referred for placement in accordance with OAC5101:2-42-90.Prior to a child’s placement in alternative care or respite, OAC 5101:2-42-90 (D) requires theAgency to share with care givers information that could impact the health, safety, or well-being of the child orothers in the home.
Article VII. INVOICING FOR PLACEMENT SERVICES
A. The Provider agrees to submit a monthly invoice following the end of the month in which services were provided.The invoice shall be for services delivered in accordance with Article I of this Agreement and shall include:
1. Provider's name, address, telephone number, fax number, federal tax identification number,Title IV-E Provider number,if applicable and Medicaid Provider number,if applicable.
2. Billing date and the billing period.3. Name of child, date of birth of child, and the child’s Statewide Automated Child Welfare Information System
(SACWIS) person I.D. number.4. Admission date and discharge date, if available.5. Agreed upon per diem for maintenance and the agreed per diem administration;and6. Invoicing procedures may also include the per diems associated with the following if applicable and
agreeable to the Agency and Provider:a. Case Management; allowable administration cost.b. Transportation, allowable maintenance cost.c. Transportation; allowable administration cost.d. Other Direct Services; allowable maintenance cost.e. Behavioral health care; non-reimbursable cost.f. Other costs - (any other cost the Title IV-E Agency has agreed to participate in); non-allowable/non-
reimbursable cost.
B. Provider warrants and represents claims made for payment for services provided are for actual services renderedand do not duplicate claims made by Provider to other sources of public funds for the same service.
Article VIII. REIMBURSEMENT FOR PLACEMENT SERVICES
A. The maximum amount payable pursuant to this contract is $9,999,999.00.B. In accordance with Schedule A of this Agreement, the per diem for maintenance and the per diem for
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administration will be paid for each day the child was in placement. The first day of placement will be paid regardless of the time the child was placed. The last day of placement will not be paid regardless of the time the child left the placement.
C. In accordance with Schedule A of this Agreement and in addition to Maintenance and Administration, the Agencymay agree to pay a per diem for Case Management, Other Direct Services, Transportation Administration,Transportation Maintenance, Behavioral Health Care and Other. All other services and/or fees to be paid for shallbe contained in the Addendum of this Agreement.
D. To the extent that the Provider maintains a foster care network, the agreed upon per diem for maintenance shallbe the amount paid directly to the foster parent. Maintenance includes the provision of food, clothing, shelter,daily supervision, graduation expenses, a child’s personal incidentals, and liability insurance with respect to thechild, reasonable cost of travel to the child’s home for visitation and reasonable cost of travel for the child toremain in the school the child was enrolled in at the time of placement. Payment for private Agency stafftransporting a child to a home visit or keeping the child in their home school will be paid in accordance withSchedule A (Transportation Maintenance) of this Agreement.
E. If the plan as determined by the Agency is to return the child to placement with the Provider, the Agency mayagree to pay for the days that a child is temporarily absent from the direct care of the Provider, as agreed to bythe parties in writing.
F. The service provider is required to utilize Medicaid-approved healthcare providers in the appropriate managedcare network for the provision of mental health, dental and/or medical services (hereafter referred to collectivelyas "medical services") to children in the custody of Agency. The Service Provider will report applicableMedicaid/insurance information to the healthcare providers and instruct healthcare providers to seek paymentfrom Medicaid or any other available third-party payer for medical services rendered to children in agencycustody. Agency will not pay for the provision of any medical services to children in agency custody unless theagency Executive Director or authorized designee has provided specific prior written authorization for suchmedical services and associated costs.
G. The Agency agrees to pay the Provider for all services agreed to on Schedule A and in the Addendum to thisAgreement, where applicable, that have been provided and documented in the child’s case file. Agency shallmake best efforts to make payment of undisputed charges within thirty (30) business days of receipt.
H. In the event of a disagreement regarding payment, Agency shall withhold payment only for that portion of theplacement with which it disagrees. Agency will use best efforts to notify the Provider of any invoice discrepancies.Agency and Provider will make every effort to resolve payment discrepancies within 60 calendar days. Paymentdiscrepancies brought to the Agency after 60 days will be reviewed on a case by case basis.
I. This Agreement is conditioned upon the availability of federal, state, or local funds appropriated or allocated forpayment for services provided under the terms and conditions of this Agreement. By sole determination of theAgency, if funds are not sufficiently allocated or available for the provision of the services performed by theProvider hereunder, the Agency reserves the right to exercise one of the following alternatives:1. Reduce the utilization of the services provided under this Agreement, without change to the terms and
conditions of the Agreement; or2. Issue a notice of intent to terminate the Agreement.
The Agency will notify the Provider at the earliest possible time of such decision. No penalty shall accrue to the Agency in the event either of these provisions is exercised. The Agency shall not be obligated or liable for any future payments due or for any damages as a result of termination under this section.
Any denial of payment for service(s) rendered may be appealed in writing and will be part of the dispute resolution process contained in Article XIV.
Article IX. TERMINATION; BREACH AND DEFAULT
A.
This Agreement may be terminated for convenience prior to the expiration of the term then in effect by either theAgency or the Provider upon written notification given no less than sixty (60) calendar days in advance by certifiedmail, return receipt requested, to the last known address of the terminated party shown hereinabove or at suchother address as may hereinafter be specified in writing.
B. If Provider fails to provide the Services as provided in this Agreement for any reason other than Force Majeure, orif Provider otherwise Materially Breaches this Agreement, Agency may consider Provider in default. Agencyagrees to give Provider thirty (30) days written notice specifying the nature of the default and its intention toterminate. Provider shall have seven (7) calendar days from receipt of such notice to provide a written plan ofaction to Agency to cure such default. Agency is required to approve or disapprove such plan within five (5)
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calendar days of receipt. In the event Provider fails to submit such plan or Agency disapproves such plan, Agency has the option to immediately terminate this Agreement upon written notice to Provider. If Provider fails to cure the default in accordance with an approved plan, then Agency may terminate this Agreement at the end of the thirty (30) day notice period.
C. Upon of the effective date of the termination, the Provider agrees that it shall cease work on the terminatedactivities under this Agreement, take all necessary or appropriate steps to limit disbursements and minimize costs,and furnish a report as of the date of discharge of the last child describing the status of all work under thisAgreement, including without limitation, results accomplished, conclusions resulting therefrom, and such othermatters as the Agency may require. The Agency agrees to remove all children in placement immediately with theProvider, consistent with the effective termination date. In all instances of termination, the Provider and Agencyagree that they shall work in the best interests of children placed with the Provider to secure alternativeplacements for all children affected by the termination.
D. In the event of termination, the Provider shall be entitled to reimbursement, upon submission of an invoice, for theagreed upon per diem incurred prior to the effective termination date. The reimbursement will be calculated by theAgency based on the per diem set forth in Article VIII. The Agency shall receive credit for reimbursement alreadymade when determining the amount owed to the Provider. The Agency is not liable for costs incurred by theProvider after the effective termination date of the discharge of the last child.
E. Notwithstanding the above, Agency may immediately terminate this Agreement upon delivery of a written notice oftermination to the Provider under the following circumstances:1. Improper or inappropriate activities;2. Loss of required licenses;3. Actions, inactions or behaviors that may result in harm, injury or neglect of a child;4. Unethical business practices or procedures; and5. Any other event that Agency deems harmful to the well-being of a child; or6. Loss of funding as set forth in Article VIII.
F. If the Agreement is terminated by Agency due to breach or default of any of the provisions, obligations, or dutiesembodied contained therein by the Provider, Agency may exercise any administrative, agreement, equitable, orlegal remedies available, without limitation. Any extension of the time periods set forth above shall not beconstrued as a waiver of any rights or remedies the Agency may have under this Agreement.
G. In the event of termination under this ARTICLE, both the Provider and the placing Agency shall make good faithefforts to minimize adverse effect on children resulting from the termination of the Agreement.
Article X. RECORDS RETENTION ,CONFIDENTIALITY AND DATA SECURITY REQUIREMENTS
A.
The Provider agrees that all records, documents, writings or other information, including, but not limited to,financial records, census records, client records and documentation of legal compliance with Ohio AdministrativeCode rules, produced by the Provider under this Agreement, and all records, documents, writings or otherinformation, including but not limited to financial, census and client used by the Provider in the performance of thisAgreement are treated according to the following terms:1.
All records relating to costs, work performed and supporting documentation for invoices submitted to theAgency by the Provider along with copies of all Deliverables, as defined in Article XXIX, submitted to theAgency pursuant to this Agreement will be retained for a minimum of three (3) years after reimbursement forservices rendered under this Agreement.
2. If an audit, litigation, or other action is initiated during the time period of the Agreement, the Provider shallretain such records until the action is concluded and all issues resolved or three (3) years have expired,whichever is later.
3. All records referred to in Section A 1) of this Article shall be available for inspection and audit by the Agency orother relevant agents of the State of Ohio (including, but not limited to, the County Prosecutor, the OhioDepartment of Job and Family Services (ODJFS), the Auditor of the State of Ohio, the Inspector General ofOhio, or any duly authorized law enforcement officials), and the United States Department of Health andHuman Services within a reasonable period of time.
B. The Provider agrees to keep all financial records in a manner consistent with Generally Accepted AccountingPrinciples.
C. The Provider agrees to comply with all federal and state laws applicable to the Agency and the confidentiality ofchildren and families. Provider understands access to the identities of any Agency’s child and families shall only be
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as necessary for the purpose of performing its responsibilities under this Agreement. No identifying information on child(ren) served will be released for research or other publication without the express written consent of the Agency. Provider agrees that the use or disclosure of information concerning the child for any purpose not directly related to the administration of this Agreement is prohibited. Provider shall ensure all the children’s and families’ documentation is protected and maintained in a secure and safe manner.
D. The Provider agrees to comply with all applicable state and federal laws related to the confidentiality andtransmission of medical records, including, but not limited to the Health Insurance Portability and Accountability Actof 1996 (HIPAA).
E. Although information about, and generated under, this Agreement may fall within the public domain, the Providershall not release information about, or related to, this Agreement to the general public or media verbally, in writing,or by any electronic means without prior approval from the Agency, unless the Provider is required to releaserequested information by law. Agency reserves the right to announce to the general public and media: award of theAgreement, Agreement terms and conditions, scope of work under the Agreement, Deliverables, as defined inArticle XXIX, and results obtained under the Agreement. Except where Agency approval has been granted inadvance, the Provider shall not seek to publicize and will not respond to unsolicited media queries requesting:announcement of Agreement award, Agreement terms and conditions, Agreement scope of work, government-furnished documents the Agency may provide to the Provider to fulfill the Agreement scope of work, Deliverablesrequired under the Agreement, results obtained under the Agreement, and impact of Agreement activities.
F. If contacted by the media about this Agreement, the Provider agrees to notify the Agency in lieu of respondingimmediately to media queries. Nothing in this section is meant to restrict the Provider from using Agreementinformation and results to market to specific business prospects.
G. Client data must be protected and maintained in a secure and safe manner whether located in Provider’s facilities,stored in the Cloud, or used on mobile devices outside Provider’s facility. Security of Provider’s network, datastorage, and mobile devices must conform to generally recognized industry standards and best practices.Maintenance of a secure processing environment includes, but is not limited to, network firewall provisioning,intrusion detection, antivirus protection, regular third-party vulnerability assessments, and the timely application ofpatches, fixes and updates to operating systems and applications.
H. Provider agrees that it has implemented and shall maintain during the term of this Agreement the highest standardof administrative, technical, and physical safeguards and controls to:1. Ensure the security and confidentiality of data;2. Protect against any anticipated security threats or hazards to the security or integrity of data; and3. Protect against unauthorized access to or use of data. Such measures shall include at a minimum:
a. Access controls on information systems, including controls to authenticate and permit access to data only toauthorized individuals and controls to prevent Provider employees from providing data to unauthorizedindividuals who may seek to obtain this information (whether through fraudulent means or otherwise);
b. Firewall protection;c. Encryption of electronic data while in transit from Provider networks to external networks;d. Measures to store in a secure fashion all data which shall include multiple levels of authentication;e. Measures to ensure that data shall not be altered or corrupted without the prior written consent of the
Agency;f. Measures to protect against destruction, loss or damage of data due to potential environmental hazards,
such as fire and water damage.
I. Immediately upon discovery of a confirmed or suspected breach involving data, Provider will notify Agency no laterthan twenty-four (24) hours after Provider knows or reasonably suspects a breach has or may have occurred.Provider shall promptly take all appropriate or legally required corrective actions and shall cooperate fully with theAgency in all reasonable and lawful efforts to prevent, mitigate or rectify such data breach. In the event of asuspected breach, Provider shall keep the Agency informed of the progress of its investigation until the uncertaintyis resolved.
J. In the event the Provider does not carry the appropriate cyber security insurance to cover a security breach, theProvider shall reimburse the Agency for actual costs incurred, including, but not limited to, providing clientsaffected by a security breach with notice of the breach, and/or complimentary access for credit monitoringservices, which the Agency deems necessary to protect such affected client.
K. In the event the Agency discontinues operation, all child records for residential or any other placement settingsshall be provided to the custodial agency. If the setting is licensed by ODJFS, licensing records shall be sent to:
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ODJFSATTN: LicensingP.O. Box 183204Columbus, OH 43218-3204
Article XI. PROVIDER ASSURANCES AND CERTIFICATIONS
A.
As applicable to the Provider’s license and/or certification, the Provider certifies compliance with ORC 2151.86,ORC 5103.0328, ORC 5103.0319 and applicable OAC Sections as defined in Article XXII of this Agreementconcerning criminal record checks, arrests, convictions and guilty pleas relative to foster caregivers, employees,volunteers and interns who are involved in the care for a child. Provider is responsible for any penalties, financialor otherwise, that may accrue because of noncompliance with this provision.
B. To the extent that the Provider maintains a residential center or group home, the Provider agrees to comply withthe provisions of their licensing Agency that relates to the operation, safety and maintenance of residentialfacilities. Specifically, Provider agrees that no firearm or other projectile weapon and no ammunition for suchweapons will be kept on the premises.
C. Provider certifies compliance with Drug Free Work Place Requirements as outlined in 45 C.F.R. Part 76,SubpartF.
D. Provider certifies compliance with 45 C.F.R. Part 80, Non-Discrimination under programs receiving Federalassistance through the Department of Health and Human Services effectuation of Title VI of the Civil Rights Act of1964.
E. Provider certifies compliance with 45 C.F.R. Part 84, Non-Discrimination on the Basis of Handicap in Programs orActivities Receiving Federal Assistance.
F. Provider certifies compliance 45 C.F.R. Part 90, Non-Discrimination on the Basis of Age in Programs or ActivitiesReceiving Federal Assistance.
G. Provider certifies compliance with the American with Disabilities Act, Public Law 101-336.H. Provider certifies that it will:
1. Provide a copy of its license(s), certification, accreditation or a letter extending an expiring license, certification,or accreditation from the issuer to the Agency prior to the signing of the Agreement.
2. Maintain its license(s), certification, accreditation and that upon receipt of the renewal of its license,certification, and/or accreditation or upon receipt of a letter extending an expiring license, certification, and/oraccreditation from the issuer, a copy of the license, certification and/or accreditation will be provided to theAgency within five (5) business days.
3. Provider shall immediately notify the Agency of any action, modification or issue relating to said licensure,accreditation or certification.
I. Provider certifies that it will not deny or delay services to eligible persons because of the person's race, color,religion, national origin, gender, orientation, disability, or age.
J. The Provider shall comply with Executive Order 11246, entitled Equal Employment Opportunity, as amended byExecutive Order 11375, and as supplemented in Department of Labor regulation 41 CFR part 60.
K. Provider further agrees to comply with OAC 5101:9-2-01 and OAC 5101:9-2-05(A)(4), as applicable, whichrequire that assure that persons with limited English proficiency (LEP) can meaningfully access services. To theextent Provider provides assistance to an LEP Child through the use of an oral or written translator orinterpretation services in compliance with this requirement, the LEP Child shall not be required to pay for suchassistance.
L. To the extent applicable, the Provider certifies compliance with all applicable standards, orders, or requirementsissued under Section 306 of the Clean Air Act (42 U.S.C. 1857 (h) Section 508 of the Clean Water Act (33 U.S.C.1368), Executive Order 11738, and Environmental Protection Agency Regulations (40 C.F.R. Part 15).
M. The Provider certifies compliance, where applicable, with mandatory standards and policies relating to energyefficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policyand Conservation Act (Pub. L. 94-163, 89 Stat. 871).
N. The Provider certifies that all approvals, licenses, or other qualifications necessary to conduct business in Ohiohave been obtained and are current.
O. Provider shall comply with the Small Business Job Protection Act (Public Law ("P.L.") 104-188), the MultiethnicPage 11 of 21
Placement Act of 1994 (P.L. 103-382), Titles IV-B (42 U.S.C. 620 et seq.) and IV-E (42 U.S.C. 670 et seq.) of the Social Security Act ("the Act"), the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193), Section 471(a) of Title IV-E of the Act (42 U.S.C. 671(a)), and 45 C.F.R. 1356, including all rules,regulations and guidelines issued by federal and state authorities, OAC 5101:9-4-07 and OAC 5101:2-47-23.1.
Article XII. INDEPENDENT CONTRACTOR
A. The Provider and the Agency agree that no employment, joint venture, or partnership has been or will be createdbetween the parties hereto pursuant to the terms and conditions of this Agreement.
B. The Provider and the Agency agree that the Provider is an independent contractor and assumes all responsibilityfor any federal, state, municipal, or other tax liabilities along with workers’ compensation, unemploymentcompensation, and insurance premiums which may accrue as a result of compensation received for services orDeliverables rendered hereunder.
C. The Provider and the Agency agree that no person and/or entities entering into this Agreement, nor any individualemployed by any person or entity entering in to this Agreement, are public employees for purposes of contributionsto Ohio Public Employees Retirement system by virtue of any work performed or services rendered in accordancewith this Agreement.
Article XIII. AUDITS AND OTHER FINANCIAL MATTERS
A. Provider agrees to submit to Agency a copy of the independent audit it receives in accordance with ORC5103.0323.
B. Upon request from the Agency, Provider shall submit a copy of the most recent Federal income tax return andrelated schedules filed with the Internal Revenue Service (IRS).
C. If Provider participates in the Title IV-E program, Provider agrees to timely file its Title IV-E cost report with allrequired items as outlined in OAC 5101:2-47-26.2 to ODJFS. Provider agrees that in the event a cost report cannotbe timely filed, an extension shall be requested prior to the December 31st filing deadline.
D. If a Provider participates in the Title IV-E program, an Agreed Upon Procedures engagement must be conducted bya certified public accountant for the Provider’s cost report in accordance with OAC 5101:2-47-26.2.The proceduresare conducted to verify the accuracy of costs used to establish reimbursement ceilings for maintenance andadministration costs of child in care. Any overpayments or underpayment of federal funds to the Title IV-E Agencydue to adjustments of cost report reimbursement ceiling amounts as a result of an audit, shall be resolved inaccordance with ORC 5101.11, ORC 5101.14. and OAC 5101:2-47-01.
E. Upon request from the Agency, the Provider shall submit a copy of the JFS 02911 and Agreed Upon Procedures.
F. For financial reporting purposes and for Title IV-E cost reporting purposes, Provider agrees to follow the costprinciples set forth in the following OAC Sections and publications:
1. OAC 5101:2-47-11: "Reimbursement for foster care maintenance costs for child's residential centers, grouphomes, maternity homes, residential parenting facilities, and purchased family foster care facilities".
2. OAC 5101:2-47-26.1: "Public child services agencies (PCSA), private child placing agencies (PCPA), privatenoncustodial agencies (PNA), residential care facilities, substance use disorder (SUD) residential facilities: TitleIV-E cost report filing requirements, record retention requirements, and related party disclosure requirements";
3. OAC 5101:2-47-26.2: "Cost Report Agreed Upon Procedures Engagement".4. JFS 02911 Single Cost Report Instructions.5. For Private Agencies: 2 CFR part 225, Cost Principles for State, Local and Indian Tribal Government.6. For Public Agencies: 2 CFR part 230, Cost Principles for Non-Profit Organizations.7. 2 CFR part 200.501, Audit Requirements.
Article XIV. GRIEVANCE /DISPUTE RESOLUTION PROCESS
In the event that a dispute arises under the provisions of this Agreement, the parties shall follow the procedures set forth below:
1.
The party complaining of a dispute shall provide written notice of the nature of the dispute to the other party to thisAgreement. A copy of the notice shall be sent to the Director or designee of the Agency and to the ExecutiveDirector or designee of the Provider. Within ten (10) business days of receiving the notice of a dispute, the partiesinvolved in the dispute between the Agency and the Provider shall attempt to resolve the dispute.
2. If the parties are unable to resolve the dispute in (1 business day), the highest official or designee of the Agency
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shall make the final determination within twenty (20) business days, which will be non-binding. 3. Neither party will be deemed to have waived any other rights or remedies available to them by initiating,
participating in or completing this process.
Article XV. AMENDMENTS
This Agreement, Addenda, and all Exhibits hereto constitutes the entire Agreement and may be amended only with a written amendment signed by both parties; however, it is agreed by the parties that any amendments to laws or regulations cited herein will result in the correlative modification of this Agreement, without the necessity for executing written amendments. The impact of any applicable law, statute, or regulation not cited herein and enacted after the date of execution of this Agreement will be incorporated into this Agreement by written amendment signed by both parties and effective as of the date of enactment of the law, statute, or regulation. Any other written amendment to this Agreement is prospective in nature.
Article XVI. NOTICE
Unless otherwise set forth herein, all notices, requests, demands and other communications pertaining to this Agreement shall be in writing and shall be deemed to have been duly given if delivered or mailed by certified or registered mail, postage pre-paid:if to Agency, to
if to Provider , to
Hamilton County Department of Job and Family Services 222 E Central PKWY FL 5Cincinnati, OH 45202
Agency NameStreet City, ST Zip
Article XVII. CONSTRUCTION
This Agreement shall be governed, construed, and enforced in accordance with the laws of the State of Ohio. Should any portion of this Agreement be found to be unenforceable by operation of statute or by administrative or judicial decision, the operation of the balance of this Agreement is not affected thereby; provided, however, the absence of the illegal provision does not render the performance of the remainder of the Agreement impossible.
Article XVIII. NO ASSURANCES
A. Provider acknowledges that, by entering into this Agreement, Agency is not making any guarantees or otherassurances as to the extent, if any, that Agency shall utilize Provider's services or purchase its goods. In this sameregard, this Agreement in no way precludes, prevents, or restricts Provider from obtaining and working underadditional arrangement(s) with other parties, assuming the work in no way impedes Provider's ability to perform theservices required under this Agreement. Provider warrants that at the time of entering into this Agreement, it has nointerest in nor shall it acquire any interest, direct or indirect, in any Agreement that will impede its ability to providethe goods or perform the services under this Agreement.
B. This Agreement, Addenda, and all Exhibits embodies the entire agreement of the Parties. There are no promises,terms, conditions or obligations other than those contained herein; and this Agreement shall supersede all previouscommunications, representations or Agreements, either written or oral, between the parties to this Agreement. Also,this Agreement shall not be modified in any manner except by an instrument, in writing, executed by both the parties.
Article XIX. CONFLICT OF INTEREST
A. Provider agrees that the Provider, its officers, members and employees currently have no, nor will they acquire anyinterest, whether personal, professional, direct or indirect, which is incompatible, in conflict with or which wouldcompromise the discharge and fulfillment of Provider’s functions, duties and responsibilities hereunder. If theProvider, or any of its officers, members or employees acquire any incompatible, conflicting, or compromisingpersonal or professional interest, the Provider shall immediately disclose, in writing, such interest to the Agency. Ifany such conflict of interest develops, the Provider agrees that the person with the incompatible, conflicting, orcompromising personal or professional interest will not participate in any activities related to this Agreement.
B. Provider agrees: (1) to refrain from promising or giving to Agency employees anything of value to manifest improperinfluence upon the employee; (2) to refrain from conflicts of interest; and, (3) to certify that Provider complies withORC 102.03, ORC 102.04 , ORC 2921.42, ORC 2921.43.
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C. The Provider further agrees that there is no financial interest involved on the part of the Agency or the respectivecounty authority(ies) governing the agency. The Provider has no knowledge of any situation which would be aconflict of interest. It is understood that a conflict of interest occurs when an Agency employee or county official willgain financially or receive personal favors as a result of signing or implementation of this agreement. The Providerwill report the discovery of any potential conflict of interest to the Agency. Should a conflict of interest be discoveredduring the term of this agreement, the Agency may exercise any right under the agreement, including termination ofthe agreement.
Article XX. INSURANCE
The Provider shall purchase and maintain for the term of this Agreement insurance of the types and amounts identified herein. Maintenance of the proper insurance for the duration of the Agreement is a material element of the Agreement.
Provider agrees to procure and maintain for the term of this Agreement the insurance set forth herein. The cost of all insurance shall be borne by Provider. Insurance shall be purchased from a company licensed to provide insurance in Ohio. Insurance is to be placed with an insurer provided an A.M. Best rating of no less than A-. Provider shall purchase the following coverage and minimum limits:
A.
Commercial general liability insurance policy with coverage contained in the most current Insurance Services OfficeOccurrence Form CG 00 01 or equivalent with limits of at least One Million Dollars ($1,000,000.00) per occurrenceand One Million Dollars ($1,000,000.00) in the aggregate and at least One Hundred Thousand Dollars($100,000.00) coverage in legal liability fire damage. Coverage will include:
1. Additional insured endorsement;2. Product liability;3. Blanket contractual liability;4. Broad form property damage;5. Severability of interests;6. Personal injury; and7. Joint venture as named insured (if applicable).Endorsements for physical abuse claims and for sexual molestation claims must be a minimum of Three Hundred Thousand Dollars ($300,000.00) per occurrence and Three Hundred Thousand Dollars ($300,000.00) in the aggregate.
B. Business auto liability insurance of at least One Million Dollars ($1,000,000.00) combined single limit, on all owned,non-owned, leased and hired automobiles. If the Agreement contemplates the transportation of the users of Countyservices (such as but not limited to Agency consumers), “Consumers” and Provider provides this service through theuse of its employees’ privately owned vehicles “POV”, then the Provider’s Business Auto Liability insurance shall sitexcess to the employees “POV” insurance and provide coverage above its employee’s “POV” coverage. Provideragrees the business auto liability policy will be endorsed to provide this coverage.
C. Professional liability (errors and omission) insurance of at least One Million Dollars ($1,000,000.00) per claim and inthe aggregate.
D. Umbrella and excess liability insurance policy with limits of at least One Million Dollars ($1,000,000.00) peroccurrence and in the aggregate, above the commercial general and business auto primary policies and containingthe following coverage:
1. Additional insured endorsement;2. Pay on behalf of wording;3. Concurrency of effective dates with primary;4. Blanket contractual liability;5. Punitive damages coverage (where not prohibited by law);6. Aggregates: apply where applicable in primary;7. Care, custody and control – follow form primary; and8. Drop down feature.The amounts of insurance required in this section for General Liability, Business Auto Liability and Umbrella/Excess Liability may be satisfied by Provider purchasing coverage for the limits specified or by any combination of underlying and umbrella limits, so long as the total amount of insurance is not less than the limits specified in General Liability, Business Auto Liability and Umbrella/Excess Liability when added together.
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E. Workers’ Compensation insurance at the statutory limits required by Ohio Revised code.F. The Provider further agrees with the following provisions:
1. All policies, except workers’ compensation and professional liability, will endorse as additional insured the Boardof County Commissioners, and Agency and their respective officials, employees, agents, and volunteers,including their Board of Trustees if applicable. The additional insured endorsement shall be on an ACORD orISO form.
2. The insurance endorsement forms and the certificate of insurance forms will be sent to the Agency Director orDesignee. The forms must state the following: “Board of County Commissioners, and Agency and theirrespective officials, employees, agents, and volunteers are endorsed as additional insured as required byagreement on the commercial general, business auto and umbrella/excess liability policies.”
3. Each policy required by this clause shall be endorsed to state that coverage shall not be canceled or materiallychanged except after thirty (30) calendar days prior written notice given to the Agency Director or Designee.
4. Provider shall furnish the Agency with original certificates and amendatory endorsements effecting coveragerequired by this clause. All certificates and endorsements are to be received by the Agency before theAgreement commences.The Agency reserves the right at any time to require complete, certified copies of allrequired insurance policies, including endorsements affecting the coverage required by these specifications.
5. Failure of the Agency to demand such certificate or other evidence of full compliance with these insurancerequirements or failure of the Agency to identify a deficiency from evidence provided shall not be construed as awaiver of Provider’s obligation to maintain such insurance.
6. Provider shall declare any self-insured retention to the Agency pertaining to liability insurance. Provider shallprovide a financial guarantee satisfactory to the Agency guaranteeing payment of losses and relatedinvestigations, claims administration and defense expenses for any self-insured retention.
7. If Provider provides insurance coverage under a “claims-made” basis, Provider shall provide evidence of eitherof the following for each type of insurance which is provided on a claims-made basis: unlimited extendedreporting period coverage, which allows for an unlimited period of time to report claims from incidents thatoccurred after the policy’s retroactive date and before the end of the policy period (tail coverage), or; continuouscoverage from the original retroactive date of coverage. The original retroactive date of coverage means originaleffective date of the first claim-made policy issued for a similar coverage while Provider was under Agreementwith the County on behalf of the Agency.
8. Provider will require all insurance policies in any way related to the work and secured and maintained byProvider to include endorsements stating each underwriter will waive all rights of recovery, under subrogation orotherwise, against the County and the Agency. Provider will require of subcontractors, by appropriate writtenagreements, similar waivers each in favor of all parties enumerated in this section.
9. Provider, the County, and the Agency agree to fully cooperate, participate, and comply with all reasonablerequirements and recommendations of the insurers and insurance brokers issuing or arranging for issuance ofthe policies required here, in all areas of safety, insurance program administration, claim reporting andinvestigating and audit procedures.
10. Provider’s insurance coverage shall be primary insurance with respect to the County, the Agency, theirrespective officials, employees, agents, and volunteers. Any insurance maintained by the County or the Agencyshall be excess of Provider’s insurance and shall not contribute to it.
11. If any of the work or Services contemplated by this Agreement is subcontractors, Provider will ensure that anysubcontractors comply with all insurance requirements contained herein.
12. If the Agreement provider is a government entity, insurance requirements will be fulfilled under the County RiskSharing Authority (CORSA).
Article XXI. INDEMNIFICATION & HOLD HARMLESS
A. To the fullest extent permitted by, and in compliance with, applicable law, Provider agrees to protect, defend,indemnify and hold harmless the Agency and the Board of County Commissioners, their respective members,officials, employees, agents, and volunteers (the "Indemnified Parties") from and against all damages, liability,losses, claims, suits, actions, administrative proceedings, regulatory proceedings/hearings, judgments andexpenses, subrogation (of any party involved in the subject of this Agreement), attorneys' fees, court costs,defense costs or other injury or damage (collectively "Damages"), whether actual, alleged or threatened,resulting from injury or damages of any kind whatsoever to any business, entity or person (including death), ordamage to property (including destruction, loss of, loss of use of resulting without injury damage or destruction)of whatsoever nature, arising out of or incident to in any way, the performance of the terms of this Agreementincluding, without limitation, by Provider, its subcontractor(s), Provider's or its subcontractor(s') employees,
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agents, assigns, and those designated by Provider to perform the work or services encompassed by the Agreement. Provider agrees to pay all damages, costs and expenses of the Indemnified Parties in defending any action arising out of the aforementioned acts or omissions.
B. Each Party agrees to be responsible for any personal injury or property damage caused solely by its negligentacts or omissions as determined by a court of competent jurisdiction, or as the parties may otherwise mutuallyagree in writing.
C. This Article is not applicable to Agreements between governmental entities.
Article XXII. SCREENING AND SELECTION
A. Criminal Record Check1. Provider warrants and represents it will comply with Article X as it relates to criminal record checks. Provider
shall insure that every individual subject to a BCII check will sign a release of information to allow inspectionand audit of the above criminal records transcripts or reports by the Agency or a private vendor hired by theAgency to conduct compliance reviews on their behalf.
2. Provider shall not assign any individual to work with or transport children until a BCII report and a criminalrecord transcript has been obtained.
3. Except as provided in Section C below, Provider shall not utilize any individual who has been convicted orplead guilty to any violations contained in ORC 5153.111(B)(1), ORC 2919.24, and OAC Chapters 5101:2-5,5101:2-7, 5101:2-48.
4. Provider agrees to be financially responsible for any audit findings resulting in financial penalty due to lack ofcompliance with the criminal records checks requirements in OAC Chapters 5101:2-5, 5101:2-7, 5101:2-48.
B. Transportation of Child1. The caregiver shall ensure the transportation of children in care will be reliable, legal and safe transportation
with safety restraints, as appropriate for the child, and must be in compliance with applicable local, state andFederal transportation laws:a. Maintenance of a current valid driver’s license and vehicle insurance.b. All children being transported by Provider must follow Ohio’s Child Passenger Safety Law as defined in
ORC 4511.81.c. No child that is a passenger and is required to have a seat restraint can be transported by said provider until
these requirements are met.
2. In addition to the requirements set forth above, Provider shall not permit any individual to transport a Child if:a. The individual has a condition which would affect safe operation of a motor vehicle;b. The individual has six (6) or more points on his/her driver’s license; orc. The individual has been convicted of, or pleaded guilty to, a violation of section 4511.19 (Operating vehicle
under the influence of alcohol or drugs – OVI or OVUAC) of the Revised Code if the individual previouslywas convicted of,or plead guilty to two or more violations within the three years immediately preceding thecurrent violation.
C. Rehabilitation1. Notwithstanding the above, Provider may make a request to the Agency to utilize an individual if Provider
believes the individual has met the rehabilitative standards of OAC 5101:2-07-02(I) as follows:
a. If the Provider is seeking rehabilitation for a foster caregiver, a foster care applicant or other resident of thefoster caregiver’s household, Provider must provide written verification that the rehabilitation standards ofOAC 5101:2-7-02 have been met.
b. If the Provider is seeking rehabilitation for any other individual serving Agency children, Provider mustprovide written verification from the individual that the rehabilitative conditions in accordance with OAC5101:2-5-09 have been met.
2. The Agency shall review the facts presented and may allow the individual to work with, volunteer with ortransport Agency children on a case-by-case basis. It is the Agency’s sole discretion to permit a rehabilitatedindividual to work with, volunteer with or transport children.
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D. Verification of Job or Volunteer Application:
Provider shall check and document each applicant’s personal and employment references, general work history,relevant experience, and training information. Provider further agrees it will not employ an individual in relation tothis Agreement unless it has received satisfactory employment references, work history, relevant experience, andtraining information.
Article XXIII. PROHIBITION OF CORPORAL & DEGRADING PUNISHMENT Agency prohibits the use of corporal or degrading punishment against children served by Agency and must comply with requirements in OAC 5101:2-7-09, OAC 5101:2-9-21, and OAC 5101:2-9-22
Article XXIV. FINDING FOR RECORDSORC 9.24 prohibits public agencies from awarding an Agreement for goods, services, or construction paid for in whole or in part from federal, state and local funds, to an entity against whom a finding for recovery has been issued if the finding is unresolved. By entering into this Agreement, Provider warrants and represents that they do not have an unresolved finding for recovery. Provider shall notify the Agency within ten (10) business days of its notification should the Provider be issued such finding by the Auditor of the State.
Article XXV. PUBLIC RECORDS
This Agreement is a matter of public record under the Ohio public records law. By entering into this Agreement, Provider acknowledges and understands that records maintained by Provider pursuant to this Agreement may also be deemed public records and subject to disclosure under Ohio law. Upon request made pursuant to Ohio law, the Agency shall make available the Agreement and all public records generated as a result of this Agreement.
Article XXVI. CHILD SUPPORT ENFORCEMENT
Provider agrees to cooperate with ODJFS and any Ohio Child Support Enforcement Agency (“CSEA”) in ensuring Provider and Provider's employees meet child support obligations established under state or federal law. Further, by executing this Agreement, Provider certifies present and future compliance with any court or valid administrative order for the withholding of support which is issued pursuant to the applicable sections in ORC Chapters 3119, 3121, 3123, and 3125.
Article XXVII. DECLARATION OF PROPERTY TAX DELINQUENCY After award of an Agreement, and prior to the time the Agreement is entered into, the successful Provider shall submit a statement in accordance with ORC 5719.042. Such statement shall affirm under oath that the person with whom the Agreement is to be made was not charged at the time the bid was submitted with any delinquent personal property taxes on the general tax list of personal property of any county in which the taxing district has territory, or that such person was charged with delinquent personal property taxes on any such tax list, in which case the statement shall also set forth the amount of such due and unpaid delinquent taxes any due and unpaid penalties and interest thereon. If the statement indicates that the taxpayer was charged with any such taxes, a copy of the statement shall be transmitted by the fiscal officer to the county treasurer within thirty days of the date it is submitted.A copy of the statement shall also be incorporated into the Agreement, and no payment shall be made with respect to any contract to which this section applies unless such statement has been so incorporated as a part thereof.
Article XXVIII. SUBCONTRACTING AND DELEGATION
The performance of any duty, responsibility or function which is the obligation of the Provider under this Agreement may be delegated or subcontracted to any agent or subcontractor of Provider if Provider has obtained the prior written consent of the Agency for that delegation subcontract. Provider is responsible for ensuring that the duties, responsibilities or functions so delegated or subcontracted are performed in accordance with the provisions and standards of this Agreement, and the actions and omissions of any such agent or subcontractor shall be deemed to be the actions and omissions of Provider for purposes of this Agreement.
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Article XXIX. PROPERTY OF AGENCY
The Deliverable(s) and any item(s) provided or produced pursuant to this Agreement (collectively called "Deliverables") will be considered "works made for hire" within the meaning of copyright laws of the United States of America and the State of Ohio. The Agency is the sole author of the Deliverables and the sole owner of all rights therein. If any portion of the Deliverables are deemed not to be a "work made for hire", or if there are any rights in the Deliverables not so conveyed to the Agency, then Provider agrees to, and by executing this Agreement hereby does, assign to the Agency all worldwide rights, title, and interest in and to the Deliverables. The Agency acknowledges that its sole ownership of the Deliverables under this Agreement does not affect Provider's right to use general concepts, algorithms, programming techniques, methodologies, or technology that have been developed by Provider prior to this Agreement or that are generally known and available. Any Deliverable provided or produced by Provider under this Agreement or with funds hereunder, including any documents, data, photographs and negatives, electronic reports/records, or other media, are the property of the Agency, which has an unrestricted right to reproduce, distribute, modify, maintain, and use the Deliverables. Provider shall not obtain copyright, patent, or other proprietary protection for the Deliverables. Provider shall not include in any Deliverable any copyrighted material, unless the copyright owner gives prior written approval for the Agency and Provider to use such copyrighted material. Provider agrees that all Deliverables will be made freely available to the general public unless the Agency determines that, pursuant to state or federal law, such materials are confidential or otherwise exempt from disclosure.
Article XXX. SEVERABILITY
If any term of this Agreement or its application thereof to any person or circumstance shall to any extent be held invalid or unenforceable, the remainder of this Agreement, or the application of such term or provision to persons or circumstances other than those as to which it is held invalid or unenforceable, shall not be affected thereby. Each term and provision of this Agreement shall be valid and enforced to the fullest extent permitted by law.
Article XXXI. NO ADDITIONAL WAIVER IMPLIED
If the Agency or Provider fails to perform any obligations under this Agreement and thereafter such failure is waived by the other party, such waiver shall be limited to the particular matter waived and shall not be deemed to waive any other failure hereunder, nor a waiver of a subsequent breach of the same provision or condition. Waivers shall not be effective unless in writing.
Article XXXII. APPLICABLE LAW AND VENUEThis Agreement and any modifications, amendments, or alterations, shall be governed, construed, and enforced under the laws of Ohio. Any legal action brought pursuant to this agreement will be filed in the Ohio courts, and Ohio law as well as Federal law will apply.IN WITNESS WHEREOF, the parties have executed this Agreement as of the date of the signature of the parties.
SIGNATURES OF PARTIES:Provider:
DatePrinted Name
Agency Name
Agency:
Printed Name Date
Hamilton County Department of Job and Family Services
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Ohio Department of Job and Family ServicesAGREEMENT FOR TITLE IV-E AGENCIES AND PROVIDERS FOR THE PROVISION
OFCHILD PLACEMENT
ADDENDA TO AGREEMENT
This Addenda sets forth the terms and conditions between the parties for placement services for children who are in the care and custody of the Agency named below.
This Agreement is between
IV-E Agency NameHamilton County Department of Job and Family ServicesStreet/Mailing Address222 E Central PKWY FL 5City State Zip CodeCincinnati OH 45202
a Title IV-E Agency, hereinafter "Agency," whose address isand
hereinafter "Provider," whose address is:
Provider
Street/Mailing Address
City State Zip Code
Contract ID : Originally Dated :date to date
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Ohio Department of Job and Family ServicesAGREEMENT FOR TITLE IV-E AGENCIES AND PROVIDERS FOR
THE PROVISION OF
CHILD PLACEMENT
Amendment Number 1 : Amendment Reason: Amendment Begin Date: Amendment End Date :Increased Amount: Article Name:
OTHERdatedate$0.00Article I. Scope of Placement Services
Amendment Reason Narrative: This amendment incorporates the attached Addendum as if such Addendum is fully set forth in the Agreement. The
Addendum ensures the Agreement meets local expectations through certain modifications and additions.
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Title IV-E Schedule A Rate InformationTitle IV-E Schedule A Rate InformationAgency : Hamilton County Department of Job and Family Services Run Date: 09/12/2019Provider / ID : Agency NameContract Period : from date - to date
Service Description
Service ID
Person Person ID
Maintenance Per Diem
Administration Per Diem
Case Management
Per Diem
Transportation /Administration
Per Diem
Transporation /Maintenance
Per Diem
Other Direct
Services Per
Diem
Behavioral Healthcare Per Diem
Other Per
Diem Cost
Total Per
Diem
Cost Begin Date
Cost End Date
Placement Per diem
11111 $ $ $ xx/xx/20xx xx/xx/20xx
PlacementPer diem
77777 $ $ $ xx/xx/20xx xx/xx/20xx
1
Contract # _______
Addendum
Due to the resulting inconsistencies between the Ohio Department of Job and Family Services Agreement for Title IV-E Agencies and Providers for the Provision of Child Placement and this Addendum, the Table of Contents is deleted in its entirety. ARTICLE I. is deleted in its entirety and replaced with following:
ARTICLE I. CONTRACTING PARTIES AND SCOPE OF PLACEMENT SERVICES
A. Contracting Parties This Addendum is entered into between the Board of County Commissioners, Hamilton County, Ohio (“County”) on behalf of the Hamilton County Department of Job & Family Services (referred herein as “HCJFS” or “Agency”) and _______, (“Provider”), with an office at ___________________________whose telephone number is (_) _______, for the purchase of Emergency Placement Services (the “Contract”). B. Scope of Service
Subject to terms and conditions set forth in this Contract and the attached exhibits, Provider agrees to perform residential treatment services for Children referred by HCJFS (“Children” or “Consumer”) as more particularly described in Exhibit VI - Request for Quote, Exhibit VII - Provider’s Quote and Exhibit II – Scope of Work, (individually, “Service”, collectively, “Services”). The parties agree that a billable unit of service is as defined in Exhibit VI – The Request for Quote, subject to Article VIII. B. The following exhibits are deemed to be a part of this Contract as if fully set forth herein: 1. Exhibit I – Reserved 2. Exhibit II – Scope of Work; 3. Exhibit III –Reporting Protocol; 4. Exhibit IV – MCP Installation & Support; 5. Exhibit V – Transition Plan; 6. Exhibit VI – The Request for Quote;
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7. Exhibit VII – Provider’s Proposal; 8. Exhibit VIII – Declaration of Property Tax Delinquency; 9. Exhibit IX – Release of Personnel Records and Criminal Record Check; 10. Exhibit X – Instant Notification Release of Information Form; and
11. Schedule A – Rate Information.
ARTICLE II. is deleted in its entirety and replaced with following: ARTICLE II. TERM
This Contract will be effective from ______ through ________ (“Initial Term”) inclusive, regardless of execution date, unless otherwise terminated by formal amendment.
ARTICLE III. is deleted in its entirety and replaced with following:
ARTICLE III. ORDER OF PRECEDENCE This Contract is based upon Exhibits II through X and Schedule A as described in Section I.B. This Contract and all exhibits are intended to supplement and complement each other and shall, where possible, be so interpreted. However, if any provision of this Contract irreconcilably conflicts with an exhibit, this Contract takes precedence over the exhibits. In the event there is an inconsistency between the exhibits, the inconsistency will be resolved in the following order: 1. Exhibit II – Scope of Work; 2. Exhibit VI – The Request for Quote; 3. Schedule A – Rate Information; then 4. Exhibit VII – Provider’s Proposal.
ARTICLE V. PROVIDER RESPONSIBILITIES - Paragraphs A. and I. are deleted in their entirety and Paragraphs D and Q are amended as follows:
D. Add the following sentence:
Agency must give prior written approval for any alternative caregivers.
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Q. Add the following as the 2nd Paragraph:
Provider further agrees to participate in and comply with the requirements of Agency utilization review, quality management and credentialing and re-credentialing programs and to observe and comply with all other protocols, policies, guidelines and programs established by Agency.
AA. The following language is added as Paragraph AA: Provider further agrees to assist Agency in securing and maintaining the educational and school enrollment documentation required by OAC 5101:2-38-08.
ARTICLE VI. AGENCY RESPONSIBILITIES - Paragraphs C., F., and J. are deleted in their entirety. ARTICLE VII.(A) is deleted in its entirety and replaced with the following:
ARTICLE VII. CONSUMER AUTHORIZATIONS and INVOICING PROCEDURE A. Form of Consumer Authorization Provider agrees that it will only provide Services to Consumers for whom it has obtained
a written pre-authorization from Agency (“Consumer Authorization”). Provider agrees it will give Agency thirty (30) days prior written notice before terminating any Consumer currently enrolled with such Provider or placed with Provider on temporary leave.
B. Reimbursement for Services
Agency will not reimburse for any Service: 1) not authorized via a Consumer Authorization; or 2) exceeding the total authorized units of service set forth on the Consumer Authorization. A unit of service is further described in Exhibit VI – The Request for Proposal).
It is the responsibility of Provider to monitor the units of service set forth on each
Consumer Authorization. Subject to paragraph C, Provider agrees that it will not receive payment for any Service which exceeds the scope of service or units or service set forth
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on a Consumer Authorization. Further, Provider will not receive payment for any Service for which no Consumer Authorization has been issued. Provider is responsible for requesting additional Consumer Authorizations prior to the time such additional Services are rendered.
C. Administrative Appeal of Denial of Consumer Authorization Provider has sixty (60) days from the date of receipt of a denial by Agency to issue a
Consumer Authorization in order to request an administrative appeal. An administrative appeal is only permitted in those cases where: 1) Service has been provided with a Consumer Authorization and such Service was rendered within the ninety (90) day period preceding the date of notification of denial of the issuance of a Consumer Authorization; or 2) Provider has requested additional Consumer Authorizations but has been denied.
D. Hold Bed Procedure
In the case of a leave of absence of a Consumer, Provider agrees to hold the Consumer’s bed for three (3) days. Agency will pay for those three (3) absence days unless Provider is otherwise notified in writing. For planned absences, including but not limited to family visits, camp, and vacation, notification to Agency of such absence must occur prior to the Consumer leaving placement. For unplanned absences, including but not limited to AWOL, hospitalization, or incarceration, Provider must notify HCJFS Utilization Management immediately of such absence. If Agency is not notified of a leave of absence, Provider will not be paid for such held bed. Provider must directly contact the HCJFS Utilization Care Manager once the Consumer has returned to placement in order to resume active authorization for Services.
Notwithstanding the above, if Provider is notified that a Consumer is able to be returned to his/her placement location, Provider shall transport the Consumer to the placement (or a similar placement) on the day of such notification. To the extent, Provider fails to return a Consumer to a placement (or a similar placement) on the day of notification, a hold bed will not be authorized and payment will not be made for such day(s).
Provider may appeal a three (3) day hold bed denial by contacting the HCJFS Utilization Management Manager, by email or fax, within three (3) days of the denial.
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E. Invoice and Payment Procedure
1. Within thirty (30) days of the end of the service month, Provider shall send an original invoice to Agency. Provider shall make all reasonable efforts to include all Service provided during the service month on the invoice. Separate invoices must be provided for each service month. All invoices must include the following information:
a. Provider’s name, address and telephone number, b. vendor number; c. Unique invoice number; d. The number of units of service supplied by Provider multiplied by the
per diem rate or unit rate, as applicable, for such Service; e. Invoice date and service dates; f. Consumer’s name and Person ID; g. PO # (Contract Services or Program area will provide this #) and
Contract #; h. The total to be paid listed on the invoice; and i. Both the Provider’s and HCJFS Program Person’s, original signature
on the invoice.
The following items are not acceptable on invoices: a. White out;
b. Stamped signatures – all signatures must be original; and c. Faxed or copied invoices.
2. Agency will not pay for any Service if: a) the invoice for such Service is
submitted to Agency more than sixty (60) calendar days from the end of the service month in which the Service was performed; or b) the invoice is incomplete or inaccurate and the Provider fails to correct or complete such invoice during the sixty (60) day period beginning at the end of the service month in which the Service was performed. Provider will not be granted an extension of time to correct timely, but incomplete or inaccurate invoices.
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3. Agency will make every reasonable effort to pay timely and accurate invoices within thirty (30) calendar days of receipt for all invoices received in accordance with the terms of this Contract. Notwithstanding any other provision of this Contract to the contrary, Agency will only pay for Services for which a Consumer Authorization was issued.
` F. Administrative Appeal of Denial of Payment
1. Denial of payment for any Service(s) rendered by Provider arising from this
Contract must be appealed, by email or fax, to Agency within sixty (60) business days from receipt of the payment denial. Provider agrees it will include all documentation to be considered with any appeal. If Provider seeks an appeal of more than one (1) claim for payment, the claims must be submitted at the same time accompanied by all required documentation.
2. The appeal will be reviewed by a HCJFS Utilization Management Specialist who
will make a recommendation to an HCJFS Utilization Management Manager. A final decision will be issued by such HCJFS Utilization Management Manager within ten (10) business days of the appeal review. The final decision will be binding.
3. If Agency approves the appeal, new invoices must be received by HCJFS within fifteen (15) business days from the date of the letter approving the appeal. New invoices received after such fifteen (15) business day time period will not be paid by Agency.
4. In no event will Agency consider any appeal of a denial of payment for Service(s)
previously appealed to HCJFS.
G. Miscellaneous Payment Provisions
1. Foster Care
In addition to complying with the payment and invoice procedures set forth above, Provider agrees to the extent: a) it is providing foster care in a Children’s Residential Center (“CRC”), group home, maternity home or residential parenting
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facility located in Ohio reimbursement at the maximum payment level is contingent on submission of the Ohio Department of Job & Family Services (“ODJFS”) 2911 “Single Cost Report;” and b) it is providing foster care in a CRC, group home, maternity home, or residential parenting facility not located in Ohio, it will follow the reimbursement procedures outlined in OAC 5101:2-47-26.1.
2. Additional Cost
The compensation paid pursuant to this Contract shall be payment in full for any Service rendered pursuant to this Contract. No fees or costs shall be charged without prior written approval of Agency.
3. Duplicate Payment
Provider warrants and represents claims made to Agency for payment for Services provided shall be for actual Services rendered to Consumers and do not duplicate claims made by Provider to other sources of public funds for the same service.
4. Remittance Address
In order to ensure timely payment of submitted invoices, Provider agrees to immediately report any changes in its organization’s remittance address to HCJFS’ contract specialist.
ARTICLE VIII. REIMBURSEMENT FOR PLACEMENT SERVICES – Paragraphs A. and E. are deleted in their entirety.
ARTICLE IX. TERMINATION; BREACH AND DEFAULT
Paragraph A. is deleted in its entirety and replaced with the following:
A. Termination for Convenience
1. By County:
This Contract may be terminated by County upon notice, in writing, delivered
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upon the Provider ninety (90) calendar days prior to the effective date of termination.
2. By Provider:
This Contract may be terminated by Provider upon notice, in writing, delivered to County and HCJFS no less than one hundred twenty (120) calendar days prior to the effective date of termination.
The following language is added as Paragraph H:
H. Force Majeure
If by reason of force majeure, the parties are unable in whole or in part to act in accordance with this Contract, the parties shall not be deemed in default during the continuance of such inability. Provider shall only be entitled to the benefit of this paragraph for fourteen (14) days if the event of force majeure does not affect Agency’s property or employees which are necessary to Provider’s ability to perform.
The term “Force Majeure” as used herein shall mean without limitation: acts of God; strikes or lockout; acts of public enemies; insurrections; riots; epidemics; lightning; earthquakes; fire; storms; flood; washouts; droughts; arrests; restraint of government and people; civil disturbances; and explosions.
Provider shall, however, remedy with all reasonable dispatch any such cause to the extent within its reasonable control, which prevents Provider from carrying out its obligations contained herein.
ARTICLE X. RECORDS RETENTION, CONFIDENTIALITY AND DATA SECURITY REQUIREMENTS the following language is added as Paragraph L:
L. Audit Requirements
1. Provider shall conduct or cause to be conducted an annual independent audit of
its financial statements in accordance with the audit requirements of ORC Chapter 117. Audits will be conducted using a “sampling” method. Depending on the type
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of audit conducted, the areas to be reviewed using the sampling method may include but are not limited to months, expenses, total units, and billable units.
2. Provider agrees to accept responsibility for receiving, replying to and complying
with any audit exception or finding, related to the provision of Services under this Contract.
Provider agrees to repay Agency the full amount of payment received for duplicate billings, erroneous billings, or false or deceptive claims. When an overpayment is identified and the overpayment cannot be repaid in one month, Provider may be asked to sign a Repayment Agreement with Agency. Provider agrees Agency may withhold any money due and recover through any appropriate method any money erroneously paid under this Contract if evidence exists of less than full compliance with this Contract. If repayments are not made according to
the agreed upon terms, future checks may be held until the repayment of funds is current. Checks held by Agency for more than sixty (60) days may be canceled and may not be re-issued. Agency reserves the right to not increase the rate(s) of payment or the overall Contract amount for Services purchased under this Contract if there is any outstanding or unresolved issue related to an audit finding. Any change to the Repayment Contract will require a formal amendment to be signed by all parties.
3. Provider agrees to give Agency a copy of Provider’s most recent annual report
and most recent annual independent audit report within sixty (60) days of receipt of such reports.
4. To the extent applicable, Provider will cause a single or program-specific audit to
be conducted in accordance with OMB Circular A-133. Provider should submit a copy of the completed audit report to Agency within sixty (60) days after receipt from the accounting firm performing such audit.
5. Agency reserves the right to evaluate programs of Provider and its subcontractors.
The evaluation may include, but is not limited to reviewing records, observing programs, and interviewing program employees and Consumers. Agency shall not be responsible for costs incurred by Provider for these evaluations.
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ARTICLE XI. PROVIDER ASSURANCES AND CERTIFICATIONS the following language is added as Paragraphs P, Q, R, S and T:
P. Provider warrants and represents that its Services shall be performed in a professional
and work like manner in accordance with applicable professional standards.
Q. Provider warrants and represents that Provider and all subcontractors who provide direct or indirect services under this Contract will comply with all requirements of federal, state and local laws and regulations, including but not limited to Office of Management and Budget Circular A-133, 2 C.F.R. Part 215, 2 C.F.R. Part 220, 2 C.F.R. Part 225, 2 C.F.R. Part 230, ORC statutes and OAC rules, and the statutes and rules of Provider’s home state in the conduct of work hereunder.
R. Provider warrants and represents all other sources of revenue have been actively pursued
prior to billing Agency for Services, including but not limited to, third party insurance, Medicaid, and any other source of local, state or federal revenue.
S. Provider warrants and represents that separate books and records, including, but not
limited to the general ledger account journals and profit/loss statements have been established and will be maintained for the revenue and expenses of this program.
T. Provider warrants and represents that it will ensure the funds from this Contract are used,
and the services for which these funds are awarded are performed, in accordance with conditions, requirements and restrictions applicable to the duties established by HCJFS and state and federal laws, as well as the federal terms and conditions of the IV-E program.
ARTICLE XII. INDEPENDENT CONTRACTOR the following language is added as Paragraph D:
D. Provider shall at all times have the status of an independent contractor without the right
or authority to impose tort, contractual or any other liability on Agency or County.
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ARTICLE XIV. GRIEVNACE/DISPUTE RESOLUTION PROCESS is deleted in entirety and replaced with the following:
ARTICLE XIV. DISPUTE RESOLUTION The Parties agree to work cooperatively to resolve any dispute in the most efficient and expeditious manner possible. Other than disputes regarding Case Plans, as described in Article XXXIII - Case Plans, either party may bring any dispute forward to the other in form of a written notice of dispute (the “Notice of Dispute”). Within thirty (30) calendar days from the time the Provider discovers or should have discovered that a matter is properly an issue that should be determined under this Article, Provider shall prepare and submit a Notice of Dispute. The Notice of Dispute shall state the facts surrounding the claim, the nature and scope of the claim, and include any proof to substantiate any dispute and a means by which to resolve the dispute in the best interest of the Parties. The Notice of Dispute shall be forwarded in writing to the following representatives of the Parties as follows: A maximum of forty-five (45) working days is allowed at each of Step 1 and Step 2 (unless extended in writing by both parties) before the dispute resolution procedure is automatically elevated to the next higher step. Step 1 representatives are as follows: Representative for Agency: HCJFS’ Unit Supervisor for Contract Services Representative for Provider: Provider’s Project Manager If an agreement cannot be reached during Step 1, the grieving party may elevate the dispute to Step 2 using the following representatives: Representative for Agency: HCJFS’ Director of Contract Services Representative for Provider: ___________________ All representatives shall communicate with each other to readily resolve items in dispute. Nothing herein shall preclude either party from pursuing its remedies available at law or in equity.
ARTICLE XVI. NOTICE the following language is added:
In addition to notification to the Agency, notice should be sent to the County at the following address:
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Board of County Commissioners, Hamilton County, Ohio 138 East Court Street Cincinnati, Ohio 45202
Attention: Administrator ARTICLE XVIII. NO ASSURANCES the following language is added as Paragraph C:
C. Provider acknowledges and agrees that only staff from the HCJFS Contract Services
Section may implement written Contract changes. In no event will an oral agreement with HCJFS be recognized as a legal and binding change to the Contract.
ARTICLE XIX. CONFLICT OF INTEREST the following language is added as Paragraph D:
D. Provider and Agency warrant that for one (1) calendar year from the beginning date of
this Contract, Provider and Agency will not solicit each other’s employees for employment. The term “Provider” includes any agent or representative of the Provider.
ARTICLE XX. is deleted in its entirety and replaced with the following:
ARTICLE XX. INSURANCE Provider agrees to procure and maintain for the term of this Contract the insurance set forth herein. The cost of all insurance shall be borne by Provider. Insurance shall be purchased from a company licensed to provide insurance in Ohio. Insurance is to be placed with an insurer provided an A.M. Best rating of no less than A-: VII. Waiver of subrogation shall be maintained by Provider for all insurance policies applicable to this Contract, as further defined in paragraph F. 7. of this Article and as required by ORC 2744.05. Provider shall purchase the following coverage and minimum limits: A. Commercial general liability insurance policy with coverage contained in the most
current Insurance Services Office Occurrence Form CG 00 01 or equivalent with limits of at least One Million Dollars ($1,000,000.00) per occurrence and One Million Dollars ($1,000,000.00) in the aggregate and at least One Hundred Thousand Dollars ($100,000.00) coverage in legal liability fire damage. Coverage will include: 1. Additional insured endorsement;
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2. Product liability; 3. Blanket contractual liability; 4. Broad form property damage; 5. Severability of interests; 6. Personal injury; and 7. Joint venture as named insured (if applicable).
Endorsements for physical abuse claims and for sexual molestation claims must be a minimum of Three Hundred Thousand Dollars ($300,000.00) per occurrence and Three Hundred Thousand Dollars ($300,000.00) in the aggregate.
B. Business auto liability insurance of at least One Million Dollars ($1,000,000.00)
combined single limit, on all owned, non-owned, leased and hired automobiles. If the Contract contemplates the transportation of the users of Consumers and Provider provides this service through the use of its employees’ privately owned vehicles “POV”, then the Provider’s Business Auto Liability insurance shall sit excess to the employees “POV” insurance and provide coverage above its employee’s “POV” coverage. Provider agrees the business auto liability policy will be endorsed to provide this coverage.
C. Professional liability (errors and omission) insurance of at least One Million Dollars ($1,000,000.00) per claim and in the aggregate.
D. Umbrella and excess liability insurance policy with limits of at least One Million Dollars ($1,000,000.00) per occurrence and in the aggregate, above the commercial general and business auto primary policies and containing the following coverage:
1. Additional insured endorsement; 2. Pay on behalf of wording; 3. Concurrency of effective dates with primary; 4. Blanket contractual liability; 5. Punitive damages coverage (where not prohibited by law); 6. Aggregates: apply where applicable in primary; 7. Care, custody and control – follow form primary; and 8. Drop down feature.
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The amounts of insurance required in this section for General Liability, Business Auto Liability and Umbrella/Excess Liability may be satisfied by Provider purchasing coverage for the limits specified or by any combination of underlying and umbrella limits, so long as the total amount of insurance is not less than the limits specified in General Liability, Business Auto Liability and Umbrella/Excess Liability when added together.
E. Workers’ Compensation insurance at the statutory limits required by Ohio Revised Code.
F. The Provider further agrees with the following provisions:
1. All policies, except workers’ compensation and professional liability, will endorse as additional insured the Board of County Commissioners Hamilton County, Ohio and its officials, employees, agents, and volunteers and Hamilton County Department of Job & Family Services, and its respective officials, employees, agents, and volunteers. The additional insured endorsement shall be on an ACORD or ISO form.
2. The insurance endorsement forms and the certificate of insurance forms will be
sent to: Risk Manager, Hamilton County, Room 707, 138 East Court Street, Cincinnati, Ohio 45202, Fax number (513) 946- 4720; and to HCJFS, Contract Services, 3rd floor, 222 East Central Parkway, Cincinnati, Ohio 45202. The forms must state the following: “Board of County Commissioners Hamilton County, Ohio and its officials, employees, agents, and volunteers and Hamilton County Department of Job & Family Services, and its respective officials, employees, agents, and volunteers are endorsed as additional insured as required by Contract on the commercial general, business auto and umbrella/excess liability policies.”
3. Each policy required by this clause shall be endorsed to state that coverage shall not be canceled or materially changed except after thirty (30) days prior written notice given to: Risk Manager, Hamilton County, Room 707, 138 East Court Street, Cincinnati, Ohio 45202; and to HCJFS, Contract Services, 3rd floor, 222 East Central Parkway, Cincinnati, Ohio 45202.
4. Provider shall furnish the Hamilton County Risk Manager and Agency with
original certificates and amendatory endorsements effecting coverage required by this clause. All certificates and endorsements are to be received by County before
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the Contract commences. County reserves the right at any time to require complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications. Failure of Agency to demand such certificate or other evidence of full compliance with these insurance requirements or failure of Agency to identify a deficiency from evidence provided shall not be construed as a waiver of Provider’s obligation to maintain such insurance.
5. Provider shall declare any self-insured retention to County and Agency pertaining
to liability insurance. Provider shall provide a financial guarantee satisfactory to County and HCJFS guaranteeing payment of losses and related investigations, claims administration and defense expenses for any self-insured retention.
6. If Provider provides insurance coverage under a “claims-made” basis, Provider
shall provide evidence of either of the following for each type of insurance which is provided on a claims-made basis: unlimited extended reporting period coverage which allows for an unlimited period of time to report claims from incidents that occurred after the policy’s retroactive date and before the end of the policy period (tail coverage), or; continuous coverage from the original retroactive date of coverage. The original retroactive date of coverage means original effective date of the first claim-made policy issued for a similar coverage while Provider was under contract with the County on behalf of HCJFS.
7. Provider will require all insurance policies in any way related to the work and secured and maintained by Provider to include endorsements stating each underwriter will waive all rights of recovery, under subrogation or otherwise, against the County and Agency Provider will require of subcontractors, by appropriate written contracts, similar waivers each in favor of all parties enumerated in this section.
8. Provider, the County, and Agency agree to fully cooperate, participate, and comply with all reasonable requirements and recommendations of the insurers and insurance brokers issuing or arranging for issuance of the policies required here, in all areas of safety, insurance program administration, claim reporting and investigating and audit procedures.
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9. Provider’s insurance coverage shall be primary insurance with respect to the County and its officials, employees, agents, and volunteers and HCJFS and its officials, employees, agents, and volunteers. Any insurance maintained by the County or Agency shall be excess of Provider’s insurance and shall not contribute to it.
If any of the work or Services contemplated by this Contract is subcontracted, Provider will ensure that any subcontractors comply with all insurance requirements contained herein.
ARTICLE XXI. is deleted in its entirety and replaced with the following:
ARTICLE XXI. INDEMNIFICATION & HOLD HARMLESS To the fullest extent permitted by and in compliance with applicable law, Provider agrees to protect, defend, indemnify and hold harmless the County and its members, officials, employees, agents, and volunteers, and Agency and its members, officials, employees, agents, and volunteers (the “Indemnified Parties”) from and against all damages, liability, losses, claims, suits, actions, administrative proceedings, regulatory proceedings/hearings, judgments and expenses, subrogation (of any party involved in the subject of this Contract), attorneys’ fees, court costs, defense costs or other injury or damage (collectively “Damages”), whether actual, alleged or threatened, resulting from injury or damages of any kind whatsoever to any business, entity or person (including death), or damage to property (including destruction, loss of, loss of use of resulting without injury damage or destruction) of whatsoever nature, arising out of or incident to in any way, the performance of the terms of this Contract including, without limitation, by Provider, its subcontractor(s), Provider’s or its subcontractor’s (s’) employees, agents, assigns, and those designated by Provider to perform the work or services encompassed by the Contract. Provider agrees to pay all Damages, costs and expenses of the Indemnified Parties in defending any action arising out of the aforementioned acts or omissions. In addition, Provider agrees to pay all Damages, liabilities, costs and expenses of the Indemnified Parties in defending any action arising regardless of any conflict of interest that may exist between the Indemnified Parties and Provider. In the event Provider fails to defend the Indemnified Parties as set forth in this Article, which may result in a breach of contract, such parties may defend themselves and Provider shall pay all actual costs and expenses for such defense including, but not limited to, judgments, awards, amounts paid in settlement, applicable
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court costs, witness fees and attorneys’ fees. The respective rights and obligations of the parties under this Article shall survive the expiration or termination of the Contract for any reason.
ARTICLE XXII. SCREENING AND SELECTION is deleted in its entirety and replaced with the following: ARTICLE XXII. SCREENING AND SELECTION
A. Criminal Record Check
Provider warrants and represents it will comply with ORC 2151.86 and will complete
criminal record checks on all individuals assigned to work with, volunteer with or transport Consumers. Provider will obtain a statewide conviction record check through the Bureau of Criminal Identification and Investigation (”BCII”) and obtain a criminal record transcript from the Cincinnati Police Department, the Hamilton County Sheriff’s Office (or appropriate local police and sheriff’ offices) and any additional law enforcement or police department necessary to conduct a complete criminal record check of each individual assigned to work with Consumers.. Individual’s record checks must be monitored annually thereafter. Annual checks may be completed via an Agency approved record search company or directly with appropriate local police or sheriff offices. Provider shall ensure that every above described individual will sign a release of information, in the form attached hereto and incorporated herein as Exhibit IX to allow inspection and audit of the above criminal records transcripts or reports by Agency or a private vendor hired by Agency to conduct compliance reviews on their behalf.
For all foster parents who are currently subject to Instant Notification System or Criminal Justice Information System (“CJIS”) screenings, BCII and FBI reports will be obtained every two (2) years for foster parents who are within six (6) months of recertification. Foster parents who reside outside of these daily criminal run areas are required to obtain an annual BCII/FBI check.
Provider must obtain a juvenile record check for any youth (other than those placed by
any PCSA or Juvenile Court) ages 10-18 residing in the foster home. Records checks will occur prior to approval of any foster home and every two (2) years thereafter. Records checks shall also occur upon a non-foster youth’s 10th birthday, or when non-foster youth who are ages 10-18 years enter the homes. Additionally, Provider and foster parent(s) shall comply with OAC reporting requirements 5101:2-7-02 and 5101:2-7-14.
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Provider shall not assign any individual to work with or transport Consumers until a BCII report and a criminal record transcript has been obtained. A BCII report must be dated within six (6) months of the date an employee or volunteer is hired.
Except as provided in Section C below, Provider shall not utilize any individual who has
been convicted or plead guilty to any violations contained in ORC 5153.111(B)(1) and OAC Chapters 5101:2-5, 5101:2-7, 5101:2-48.
B. Provider warrants and represents it will secure a release for an annual Central Registry
report from all individuals assigned to work with or transport Consumers. Instructions and guidance on how to obtain this clearance can be found at https://jfs.ohio.gov/ocf/childprotectiveservices.stm.
C. All completed and documented checks shall be maintained in the employee file.
1. Provider shall ensure that every above described individual will sign a release of information, attached hereto and incorporated herein as Exhibit IX - Release of Personnel Records and Criminal Record Check to allow inspection and audit of the above Central Registry report by HCJFS or anyone conducting compliance reviews on their behalf.
2. Provider shall not assign any individual to work, volunteer with or transport consumers until a Central Registry report has been obtained. A Central Registry report must be dated within six (6) months of the date an employee is hired.
D. Requirements for the Transportation of Consumers
Any individual transporting Consumers shall possess the following qualifications: 1. Prior to allowing an individual to transport a Consumer, an initial satisfactory
Bureau of Motor Vehicle (“BMV”) transcript from the State of Ohio (or the state the provider conducts its business) and, if applicable, from the individual’s state of residence must be obtained;
2. Thereafter, an annual satisfactory BMV abstract report must be obtained from the State of Ohio (or the state the provider conducts its business) and, if applicable, from the individual’s state of residence; and
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3. Maintenance of a current and valid driver’s license.
Provider must, at all times, comply with Ohio’s Child Passenger Safety Law as set forth in Ohio Revised Code 4511.81 while transporting any Consumer. In this same regard, no Consumer that that is required to have a seat restraint can be transported by Provider until such requirement is met.
In addition to the requirements set forth above, Provider will not permit any individual to transport a Consumer if:
1. the individual has a condition which would affect safe operation of a motor vehicle;
2. the individual has six (6) or more points on his/her driver’s license; or
3. the individual has been convicted of driving while under the influence of alcohol or drugs.
E. Rehabilitation
Notwithstanding the above, Provider may make a request to HCJFS to utilize an individual if Provider believes the individual has met the rehabilitative standards of Ohio Administrative Code Section 5101 as follows: 1. If the Provider is seeking rehabilitation for a foster caregiver, a foster care
applicant or other resident of the foster caregiver’s household, Provider must provide written verification that the rehabilitation standards of OAC 5101:2-7-02 have been met.
2. If the Provider is seeking rehabilitation for any other individual serving
Consumers, Provider must provide written verification from the individual that the rehabilitative conditions of OAC 5101:2-5-09 have been met.
Agency will review the facts presented and may allow the individual to work with,
volunteer with or transport HCJFS Consumers on a case-by-case basis. It is Agency’ sole discretion whether to permit a rehabilitated individual to work with, volunteer with or transport our Consumers.
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F. Verification of Job or Volunteer Application Provider will check and document each applicant’s personal and employment
references, general work history, relevant experience, and training information. Provider further agrees it will not employ an individual to provide Services in relation to this Contract unless it has received satisfactory employment references, work history, relevant experience, and training information.
THE TITLE TO ARTICLE XXIV. FINDING FOR RECORD is hereby amended to read as FINDINGS FOR RECOVERY ARTICLE XXVIII. SUBCONTRACTING AND DELEGATION is deleted in its entirety and replaced with the following:
ARTICLE XXVIII. SUBCONTRACTING AND DELEGATION The parties expressly agree this Contract shall not be assigned by Provider without the prior written approval of Agency. Provider may not subcontract any of the Services agreed to in this Contract without the express written consent of Agency. Notwithstanding any other provisions of this Contract affording Provider an opportunity to cure a breach, Provider agrees the assignment of any portion of this Contract or use of any subcontractor, without Agency’s prior written consent, is grounds for Agency to terminate this Contract with one (1) day prior written notice. All subcontracts are subject to the same terms, conditions, and covenants contained within this Contract. Provider agrees it will remain primarily liable for the provision of all Services under this Contract and it will monitor any approved subcontractors to assure all requirements under this Contract, including, but not limited to reporting requirements, are being met. Provider must notify HCJFS within one (1) business day when Provider knows or should have known the subcontractor is out of compliance or unable to meet Contract requirements. Should this occur, Provider will immediately implement a process whereby subcontractor is immediately brought into compliance or Provider will terminate subcontractor’s involvement in this Contract. If Provider decides to bring subcontractor into compliance, Provider shall provide Agency with written documentation regarding how compliance will be achieved and the timetable for any required action. If Provider decides to terminate subcontractor, Provider shall notify Agency of subcontractor’s termination and shall make recommendations Agency of a replacement
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subcontractor. All replacement subcontractors are subject to the prior written consent of Agency. Provider is responsible for making direct payment to all subcontractors for any and all Services provided by such contractor.
THE TITLE TO ARTICLE XXX. SEVERABILITY is hereby amended to read as WAIVER AND SEVERABILITY. The following language is added as Paragraph 1 to Article XXX:
Any waiver by either party of any provision or condition of this Contract shall not be construed or deemed to be a waiver of any other provision or condition of this Contract, nor a waiver of a subsequent breach of the same provision or condition.
ARTICLE XXXII. APPLICABLE LAW AND VENUE is deleted in its entirety and replaced with the following:
ARTICLE XXXII. APPLICABLE LAW AND VENUE
Each party hereto submits to the exclusive jurisdiction of any state court sitting in the County of Hamilton, State of Ohio, in any action or proceeding arising out of or relating to this Contract, agrees that all claims in respect of the action or proceeding shall be heard and determined in any such court, waives any objection to venue therein, and agrees not to bring any action or proceeding arising out of or relating to this Contract in any other court. The parties further agree that this choice of venue is to be considered mandatory, and not optional in nature, thereby precluding the possibility of litigation in any venue or jurisdiction other than that specified in this section. The Parties further agree that any final judgment rendered in any such action or such proceeding, as provided herein, shall be conclusive as to the subject matter of such final judgment, subject only to the right of appeal provided by the laws of the State of Ohio, and that once any such right of appeal has been exhausted or waived, such final judgment may be enforced in other jurisdictions in any manner provided by law.
The following ARTICLES are added:
ARTICLE XXXIII. CASE PLAN Provider agrees to participate with Agency in the development, modification and implementation of a case plan (the “Case Plan”) for each Consumer placed with Provider. Such Case Plans will
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be developed and maintained in coordination with any treatment plans developed for a Consumer. Agency shall provide a copy of the Case Plan to the Provider within thirty (30) days of placement of the Consumer or such time as may be agreed to from time to time by the parties, in writing. The Parties agree to work cooperatively to resolve all disputes regarding a Case Plan through the use of a joint case conference. If a dispute related to a Case Plan cannot be resolved from a joint case conference, the parties agree Agency shall be the sole authority to render a decision on such dispute. The provisions of Article XIV Dispute Resolution shall not apply to disputes regarding Case Plans. ARTICLE XXXIV. MAINTENANCE OF SERVICE Provider certifies the Services being reimbursed are not available from the Provider on a non-reimbursable basis or for less than the rate of payment and that the level of service existing prior to the Contract, if any, shall be maintained. Provider further certifies federal funds will not be used to supplant non-federal funds for the same service. ARTICLE XXXV. MANAGED CARE PARTNERSHIP
Providers are required to use MCP for clinical record-keeping, obtaining prior authorizations and reporting. The system specifications associated with using MCP are listed in Exhibit III, MCP Installation & Support. For purposes of this Contract, Managed Care Partnership (MCP) is the Management Information System created by HCJFS to house on-line Consumer specific information for HCJFS Consumers in placement. Information obtained by Provider from MCP must be obtained solely for business reasons. Additionally, if the information is printed it must be secured in a manner which is deemed to be in compliance with federal and state law, including but not limited to be in compliance with federal and state law, including but not limited to HIPAA.
ARTICLE XXXVI. REPORTS A. Provider agrees to report all cases of suspected abuse, neglect or dependency to Agency
through (513) 241-KIDS, the child welfare hotline for Agency. In this same regard, Provider agrees to follow Agency’s policies and procedures for reporting such cases, which are set forth in Exhibit III. Provider agrees to cooperate and assist in any
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investigation and follow-up activities occurring in relation to such cases. The parties agree changes to Exhibit III made by Agency will be sent to Provider and considered incorporated into this Contract without the need for an amendment to this Contract.
B. The monthly contract program financial report shall be submitted to HCJFS Contract
Services Section no later than forty-five (45) days after the end of the service month. This report is required if Provider serves an average of ten (10) or more Consumers each month.
C. Agency reserves the right to request additional reports at any time during the Initial Term
or any Renewal Term. It is the responsibility of Provider to furnish Agency with such reports as requested. Agency may exercise this right without a Contract amendment.
D. HCJFS reserves the right to withhold payment until such time as all required reports are
received.
ARTICLE XXXVII. PROVIDER GRIEVANCE PROCESS Provider will post its grievance policy and procedures in a public or common area at each contracted site so all Consumers and representatives are able to review Provider’s policy. Provider will notify Agency in writing, on a monthly basis, of all grievances initiated by Consumers or their representatives involving the Services. Provider shall submit any facts pertaining to the grievance and the resolution of the grievance to HCJFS Contract Manager, no less frequently than monthly. ARTICLE XXXVIII. INSTANT NOTIFICATION Provider agrees to submit to Agency, prior to the date on which Services are commenced a signed Release of Information (“ROI”) form, Exhibit X, for each foster caregiver and any adult who has lived in a foster home for more than a two (2) week period (“co-habitant”). Provider further agrees that it will submit a signed ROI to HCJFS upon the occurrence of any of the following events: a) any youth living in the foster home turns eighteen (18) years of age; b) any adult plans to live with a foster caregiver for more than a two week period; and, c) any adult lives with a foster caregiver for a two (2) week period and has not submitted a ROI.
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If at any time Provider anticipates that it will place a HCJFS Consumer with a new foster caregiver, a signed ROI must be submitted for each foster caregiver and co-habitant prior to the time such placement is made. The ROI must contain the foster caregiver’s or co-habitant’s name, alias (if any), date of birth, address and phone number. Provider understands that Agency will submit the ROI to the Hamilton County Clerk of Courts who will conduct daily cross checks of the names with records it maintains of criminal charges. Agency reserves the right to terminate this Contract immediately, upon notice, if a Consumer is placed in any foster home for which Agency has not received a signed ROI for each foster caregiver and co-habitant. OAC 5101:2-7-14(G) requires foster caregivers to notify Provider, within twenty-four (24) hours, of any charge of any criminal offense brought against the foster caregiver or any co-habitant in the home. Agency reserves the right to terminate this Contract immediately for failure of Provider to notify Agency of any notification it has received of a charge of any criminal offense against a foster caregiver or co-habitant. ARTICLE XXXIX. RESIDENTIAL FACILITY OPERATION AND SAFETY REQUIREMENTS
Provider agrees to comply with the provisions of OAC 5101:2-9 et seq. that relates to the operation, safety and maintenance of residential facilities. Specifically, Provider agrees that no firearm or other projectile weapon and no ammunition for such weapons will be kept on the premises. ARTICLE XL. LOBBYING During the life of this Contract, Provider affirms that Provider has not and will not use Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any Federal agency, a member of Congress, office or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. § 1352. Provider further certifies compliance with all lobbying restrictions, including 31 USC 1352, 2 USC 1601, 45 CFR 93 and any other federal law or rule pertaining to lobbying.
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Provider further warrants and represents that Provider shall disclose any lobbying with any non-Federal funds that takes place in connection with obtaining any Federal award. If Provider fails to notify Agency, Agency reserves the right to immediately suspend payment and terminate this Contract. ARTICLE XLI. RESERVED ARTICLE XLII. DEBARMENT AND SUSPENSION Provider will, upon notification by any federal, state, or local government agency, immediately notify HCJFS of any debarment or suspension of Provider being imposed or contemplated by the federal, state or local government agency. Provider will immediately notify HCJFS if it is currently under debarment or suspension by any federal, state, or local government agency. ARTICLE XLIII. ANTI-DISCRIMINATION REQUIREMENTS A. Provider agrees to comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. §
2000d et seq.), Title IX of the Education Amendments of 1972 (20 U.S.C. §1681 et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794), the Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.); Title II of the Americans with Disabilities Act of 1990 (42 U.S.C § 12131 et seq.); all provisions required by the implementing regulations of the Department of Agriculture and Department of Health and Human Services; Department of Justice Enforcement Guidelines, 28 CFR 50.3 and 42; and Department of Agriculture, Food and Nutrition Services (FNS) directives and guidelines to the effect that, no person shall on the grounds of race, color, national origin, sex, age, disability or political beliefs or association, be excluded from participation in, be denied benefits of, or otherwise be subject to discrimination under any program or activity for which the program applicant receives Federal financial assistance from FNS.
B. Provide shall post the most recent version of the AD- 475A and/or AD-475B “And Justice for All” poster
ARTICLE XLIV. CONTRACT CLOSEOUT At the discretion of Agency a Contract Closeout may occur within ninety (90) days after the completion of all contractual terms and conditions. The purpose of the Contract Closeout is to
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verify that there are no outstanding claims or disputes and to ensure all required forms, reports and deliverables were submitted to and accepted by Agency in accordance with Contract requirements.
ARTICLE XLV. HCJFS CONTACT INFORMATION
A. HCJFS Contacts -Provider should contact the following Agency staff with questions:
Name & Email Address Telephone Facsimile Department Responsibility
(513) 946- (513)
946-2384
Contract Services contract
changes,
contract
language
(513) 946- (513)
946-
Program
Management
service point of
contact, service
authorization,
invoice review
Yonas Asmeron
or Jill Flake
(513) 946-1514
(513) 946-1607
(513)
946-
Fiscal billing &
payment,
invoice
processing
Stacy Woosley
(513) 946-2079 (513)
946-
Utilization
Management
appeals
Brian Gregg, [email protected]
co.org
(513) 946-1728 Communications
Director
Media inquiries,
media and
communications
questions
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B. Provider Contacts - Agency should contact the following Provider staff with any questions:
Name & Email Address Telephone Facsimile Department Responsibility
Business
Management
contract changes,
contract language
Program
Management
service point of
contact, service
referral contact
ARTICLE XXXIX. FOSTER CARE SITE OPERATION AND SAFETY
REQUIREMENTS
Provider agrees to comply with the provisions of OAC 5101:2-7, et seq. relating to the operation, safety and maintenance of foster homes.
ARTICLE XLVII. TRANSITION PLAN The Transition Plan to be used in the event of termination or expiration of this Contract is attached to and incorporated into this Contract as Exhibit V. The goals of the Transition Plan are to: a) ensure continuity of care; b) not disrupt care unnecessarily; and c) ensure the safety of Consumers and their families. The Parties agree that each shall provide reasonable cooperation in the transitioning of responsibilities to any other person or entity selected by HCJFS to assume administration of such responsibilities. To ensure continuity of Services to Consumers and families, the Transition Plan, at a minimum, includes the following schedule:
A. Consumer records will be provided to Agency thirty (30) days prior to the
termination date of the Contract; B. A monthly Service Authorization report will be provided to Agency or designee
until the termination date of the Contract; and C. “Data dump” to Agency of all Consumer data from Provider’s electronic systems
will occur within thirty (30) days after the termination date of the Contract. Agency reserves the right to waive any of the above Transition Plan requirements and dates at its sole discretion.
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ARTICLE XLVIII. NON-EXCLUSIVE This is a non-exclusive Contract, and Agency may purchase the same or similar item(s) from other providers at any time during the term of this Contract.
ARTICLE XLIX. PUBLIC ASSISTANCE WORK PROGRAM PARTICIPANTS Pursuant to ORC Chapter 5107 and 5108, the Prevention, Retention, and Contingency Program, Provider agrees to not discriminate in hiring and promoting against applicants for and participants for the Ohio Works First Program. Provider also agrees to include such provision in any such contract, subcontract, grant or procedure with any other party which will be providing services, whether directly or indirectly, to Consumers. ARTICLE L. MARKETING Any program description intended for internal or external use shall contain a statement that funding for such program is provided by the Board of County Commissioners, Hamilton County, Ohio on behalf of the Hamilton County Department of Job & Family Services. ARTICLE LII. PROVIDER EMPLOYEES/FAMILY MEMBERS Under no circumstance are Provider’s employees, or family members, permitted to be foster parents for Provider. The employee/family members of the agency must be licensed and their homes supervised by another foster care agency.
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The terms of this Contract are hereby agreed to by the Parties, as shown by the signatures of representatives of each.
SIGNATURES In witness whereof, the parties have hereunto set their hands on this day of _____, 20 . Provider or Authorized Representative: _________________________________________ Title: _______________________________________________________ Date: __________ Honorable Board of County Commissioners Hamilton County, Ohio By: By: By:
OR By: Date: _________________
Jeffrey Aluotto, County Administrator Hamilton County, Ohio
OR By: Date: __________________
Purchasing Director Hamilton County, Ohio
Recommended: By: Date: ______________
Moira Weir, Director Hamilton County Department of Job & Family Services
Approved as to form: By: _______________________________________ Date: _____________
Prosecutor’s Office Prepared By: ___ Hamilton County, Ohio Checked By: ___
Approved By: ___
G:\SHAREDSV\CONTRACT\MASTERS\ITB_RFP_Masters - Declaration of Property Tax Delinquency 6-8-11.doc
Declaration of Property Tax Delinquency (ORC 5719.042)
I, ____________________________, hereby affirm that the Proposing Organization
herein, ________________________________________, is ____ / is not ____ (check
one) at the time of submitting this proposal charged with delinquent property taxes on the
general tax list of personal property within the County of Hamilton. If the Proposing
Organization is delinquent in the payment of property tax, the amount of such due and
unpaid delinquent tax and any due and unpaid interest is $__________________.
Print Name____________________________________________ Date_______________
Signature _________________________________________________________________
State of Ohio - County of Hamilton Notary
Before me, a notary public in and for said County, personally appeared
______________________________, authorized signatory for the Proposing Organization,
who acknowledges that he/she has read the foregoing and that the information provided
therein is true to the best of his/her knowledge and belief.
IN TESTIMONY WHEREOF, I have affixed my hand and seal of my office at
__________________________, Ohio this ______ day of _________ 20____.
______________________________
Notary Public
222 East Central Parkway • Cincinnati, Ohio 45202-1225
General Information: (513) 946-1000 General Information TDD: (513) 946-1295
FAX: (513) 946-2250 www.hcjfs.org
www.hcadopt.org www.hcfoster.org
Employer Name:
Employee Name:
Employee Address:
Authorization Date:
Expiration Date:
RELEASE OF PERSONNEL RECORDS AND CRIMINAL RECORD CHECKS Whereas R.C. 2151.86 requires the Hamilton County Department of Job and Family Services (HCJFS) to obtain a criminal records check on each employee and volunteer of a HCJFS Provider who is responsible for a consumer’s care during service delivery, and Whereas HCJFS, and HCJFS’ funding organizations, may be required to audit the records of Providers to ensure compliance with provisions relating to criminal record checks of Providers’ employees who are responsible for a consumer’s care during service delivery, and NOW THEREFORE I authorize HCJFS, and those entitled to audit its records, to review my personnel records, including, but not limited to, criminal records checks. This authorization is valid for this, and the three subsequent fiscal years of HCJFS. Signature________________________________________ Date _____________________ A. Criminal Record Check Provider shall comply with R.C. Sections 2151.86 and 5153.111. Generally these require that every employee or volunteer of Provider who has contact with a Consumer have an effective criminal record check. Notwithstanding the aforesaid, an employee or volunteer, without an effective criminal record check, may have contact with a Consumer if he/she is accompanied by an employee with an effective criminal record check. As used in this section an “effective criminal record check” is a criminal record check performed by the Ohio Bureau of Criminal Identification and Investigation, done in compliance with ORC 2151.86, which demonstrates that the employee or volunteer has not been convicted of any offense listed in R.C. Section 2151.86(C).